Your Journey to Recovery and Wellness
A Cardiac Education Manual A Message from the Physicians and Staff of the TriHealth Heart Institute
Dear Patient,
Thank you for choosing TriHealth Heart Institute for your care. Whether you are here suddenly and unexpectedly or after careful consideration of all your health care choices, we want you to know that you are in capable hands.
TriHealth Heart Institute was created to provide seamless, patient-centered care for heart patients. We’re dedicated to offering the most up-to-date, minimally invasive treatment options. We have received national recognition for quality heart care and we participate in clinical trials to bring leading treatments and procedures to our patients. Our physicians work together across all disciplines to ensure that each patient gets the care and treatment that is best for them. In fact, our entire staff is dedicated to providing quality care, from our nurses and staff to our testing centers and physician practice offices.
Our commitment to you is to do everything we can to help you return to good health. This book is a tool packed with information you need to get back on your feet as quickly as possible. Your nurses will work with you to get the most out of this book while you are here, and then we encourage you to take it home as an ongoing reference as you recover.
We wish you the best in your treatment and recovery, as we work together to help you live better.
Sincerely,
The Physicians and Staff of the TriHealth Heart Institute Table of Contents
Understanding Your Heart and Common Heart Conditions...... 1
Cardiac Testing...... 11
Your Heart Medications...... 15
Lifestyle Changes for a Healthier Heart...... 29
Eating with Your Heart’s Consent...... 41
Exercising for a Healthier Heart...... 71
Living with Heart Failure...... 77
Your Diagnosis and Treatment: Coronary Artery Procedures...... 91
Your Treatment: Heart Surgery...... 97
Heart Surgery: Information for the Family...... 117
Electrical Problems of the Heart...... 121
Diabetes Management...... 129
© 2013 by TriHealth, Inc. All rights reserved.
TriHealth.com Heart Diagram
Aorta
Left Main Artery
Left Circumflex Artery
Left Anterior Descending Artery
Right Coronary Artery
Aorta
Pulmonary Veins
Left Atrium Pulmonary Artery Right Atrium Aortic Mitral Valve Valve Pulmonary Valve Left Tricuspid Ventricle Valve Right Ventricle
© 2013 by TriHealth, Inc. All rights reserved. Understanding Your Heart and Common Heart Conditions
In this section, you will learn how the heart regurgitation or insufficiency. If a valve doesn’t works and the important role played by the open all the way, less blood moves through the coronary arteries, valves and electrical system opening. This is called stenosis. Valve problems cause the heart to work harder to pump the of the heart. You also will receive some basic same amount of blood. Fluid may back up information about irregular heartbeats, in the lungs or body and can cause swelling, coronary artery disease, angina (chest pain) shortness of breath and dizziness. and heart attacks. Septal Defects How the Heart Works The atrial septum is a wall of tissue that The heart is a muscle about the size of an adult separates the upper chambers of the heart. male fist. Its job is to pump blood to all parts of An atrial septal defect (ASD) is a hole or opening the body. in this wall that fails to close during the body’s development before birth. The heart is made up of four chambers that hold and pump blood. The top two chambers The ventricular septum divides the two lower are the right atrium and left atrium. The atria chambers (ventricles) of the heart. A ventricular collect blood returning to the heart from the septal defect (VSD) is an opening that can be veins. The atria then release the blood into the caused by a birth defect or by an extensive bottom chambers through valves. Heart valves heart attack. act as one-way doors to separate the chambers and keep the blood moving forward. If the hole in the septum is large enough to increase the risk of bacterial infection or The bottom two chambers are called the right cause problems in pressure between two ventricle and left ventricle. A wall (septum) heart chambers, surgery may be needed. separates the two right chambers from the two During surgery, the hole is covered by a patch left chambers. Because of this, you may hear or simply closed by sewing the edges of the your heart described as two pumps, the “right opening together. heart” and the “left heart.” When the ventricles contract, they force blood out of the heart to different parts of the body. In an average lifetime, the heart beats more than The heart is surrounded by a tough protective two and a half billion times. The fist-sized organ sac called the pericardium. beats 100,000 times per day, pumping five or six quarts of blood each minute or about 2,000 Valve Conditions gallons per day.
There are four heart valves that act as one- way doors to keep blood moving in the right direction through the heart. Valve disease occurs when a valve doesn’t work the way it should. If a valve doesn’t close all the way, blood may leak backward. This is called
1 Understanding Your Heart and Common Heart Conditions
The Heart’s Electrical System of the heart (atria) when and how fast to pump. It is the “pacemaker” of the heart. The signal The heart’s pumping action is controlled by then is sent to the AV node in the middle of an electrical system that sends out impulses, the heart. The AV node holds the signal until or signals. the bottom chambers of the heart (ventricles) are filled with blood. It then sends the signal An electrical signal starts in the right atrium to the ventricles and tells them to pump the in the sinus node. The sinus node tells the top blood out to the body.
The Heart’s Electrical Pathway 1. Sinus node 2. Right atrium 3. Left atrium 3 4. AV node 5. Impulses spread through ventricles 6. Right ventricle 1 7. Left ventricle 2 4 5 7 6
2 Understanding Your Heart and Common Heart Conditions
Irregular Heartbeat Atrial Fibrillation (A-fib) (Cardiac Arrhythmia) Atrial fibrillation, or A-fib, is a problem with your heart rhythm. Symptoms of A-fib include Irregular heartbeat, or cardiac arrhythmia, is palpitations, weakness, tiredness, shortness a problem with your heart rhythm. The heart of breath, chest pain or tightness, dizziness may beat too fast or too slowly, or may skip or fainting. beats. You may feel palpitations: a rapid heart rate, skipped beats, thumping or pounding in A-fib occurs in the upper chambers (atria) your chest. Cardiac arrhythmias may make of the heart. The cells in the atria send out you feel anxious, nervous, dizzy, faint or short extra signals, making the atria beat very quickly of breath. and unevenly. Sometimes the atria beat so fast that they may quiver instead of contracting. Cardiac arrhythmias often are controlled If the atria don’t contract, they can’t move with medications. Your doctor may want enough blood into the ventricles. Blood that to do further testing, however, to determine isn’t moving can easily form into clots. These other treatments. clots can then move to other parts of the body causing serious health problems, such Premature Ventricular Beats (PVCs) as a stroke. Premature ventricular beats, or PVCs, is a problem where the heart has extra beats. A-fib is rarely life-threatening. It can occur PVCs can occur after a heart attack or may following a heart attack, with high blood have no known cause. pressure or thyroid problems, or it may have no known cause. A-fib is very common, PVCs occur in the ventricles, the lower affecting people of all ages. It can lead to chambers of the heart, and may feel like other problems such as stroke or heart skipped beats or extra beats. After a heart failure. However, these problems can be attack, PVCs may stop after the heart begins avoided if the condition is managed. to heal. If the PVCs continue or are causing problems, your doctor may prescribe Your doctor may prescribe tests that will help medication. diagnose your A-fib. These tests may include EKG, echocardiogram or electrophysiology Ventricular Fibrillation (V-fib) studies (EPS). Ventricular fibrillation, or V-fib, is a life- threatening arrhythmia. It comes on suddenly A-fib often is controlled with medications. with chest pressure, shortness of breath and The three most common medications that are fainting. It is also known as “sudden death,” used to slow down the speed of the heart rate because it is often fatal. V-fib requires rapid are digoxin, calcium channel blockers and beta defibrillation or shock treatment within minutes blockers. You also may be given medication to restore a normal heart rhythm. You may have to prevent clots from forming in the atria. noticed automatic external defibrillators (AED) These medications are called anticoagulants. in public places. They are used to administer The most common anticoagulant is called shock treatment. If you are at risk for V-fib, Coumadin (warfarin). your doctor may recommend an internal cardiac defibrillator (ICD) and/or medication.
3 Understanding Your Heart and Common Heart Conditions
Coronary Arteries Plaque deposits can sometimes rupture if they become inflamed or unstable. A rupture can The coronary arteries lie on the outside surface cause a blood clot to form in the narrowed area. of the heart. The right coronary artery (RCA) supplies blood to the right side of the heart. A blood clot (thrombus) can block the The left coronary artery starts as the left artery’s flow of blood, causing severe pain main artery and divides into the left anterior and a heart attack. descending (LAD) and circumflex (Cx) arteries. The left coronary artery supplies blood to Coronary Artery Disease the left side of the heart. Coronary arteries The inside of a coronary artery has a smooth are about the size of cooked spaghetti. Many lining through which blood easily flows. smaller branches lead from these main arteries. Coronary artery disease starts when the lining of the coronary artery is damaged. This often The heart gets its blood supply from the is due to a risk factor, such as smoking, obesity, coronary arteries. Blood is pumped from elevated total or LDL cholesterol, hypertension the left ventricle into the aorta, a large artery or diabetes. A plaque deposit (a fatty material coming off of the left ventricle. The aorta composed of cholesterol and other abnormal supplies blood to the arteries of the heart cells) forms between layers of the artery wall. as well as to the rest of the body. This buildup, called atherosclerosis, causes the arteries to become stiff and slows the flow of Problems occur if the left ventricle is damaged blood to the heart muscle. Over time, buildup and cannot pump enough blood to the coronary of stable plaque can clog the artery and cause arteries. If blockages in the coronary arteries a partial or total blockage. prevent blood from flowing smoothly, the heart muscle may not receive enough oxygen and nutrients to pump blood as it should.
Plaque formation occurs when the lining Plaque deposits can sometimes rupture of the artery becomes damaged and allows if they become inflamed or unstable. abnormal cells and fatty deposits to form A rupture can cause a blood clot between layers of the artery wall. to form in the narrowed area.
Progression of plaque narrows the channel where blood flows.
A blood clot (thrombus) can block the artery's flow of blood, causing severe pain and a heart attack.
4 Understanding Your Heart and Common Heart Conditions
Another way a coronary artery blockage can When angina occurs: occur is when a plaque deposit becomes • Stop the activity. This is a sign your heart is not inflamed and unstable and actually ruptures getting enough oxygen. inside the artery (see figure on opposite page). • Rest. A rupture can narrow the artery even more and • If the pain does not go away in one to two minutes, can cause a blood clot to form. If the blood place a nitroglycerin tablet under your tongue and clot is large enough, it will cut off blood flow sit down. immediately, and severe chest pain or a heart • If the pain does not go away in five minutes, take attack will result. If the heart muscle does not another nitroglycerin. receive enough blood and oxygen, it is called • If the pain still doesn’t go away, call 911, take ischemia. A symptom of ischemia is chest pain, another nitroglycerin and one uncoated aspirin. called angina. The aspirin acts as a blood thinner.
Plaque formation occurs when the lining Ways to avoid angina include: of the artery becomes damaged and allows • Eat small, frequent meals. abnormal cells and fatty deposits to form • Avoid heavy exercise or physical activity between layers of the artery wall. for one hour after eating. • Check your heart rate during activity and do not Progression of plaque narrows the channel exceed 20 beats above resting. where blood flows. • Do not stay out for long periods in very hot or very cold temperatures (above 80° F, below 32° F) Angina or in high humidity. • Avoid hot tubs and saunas. Angina is not a disease but a symptom of heart • Manage stress. trouble. It is a pain or discomfort that happens • Take your medications as prescribed by when part of the heart muscle is not getting your doctor. enough blood. It is usually brief, lasting just a few minutes.
You may have pressure, tightness or pain in your chest, arms, shoulder, neck, jaw or upper back, or have stomach indigestion.
Angina discomfort often is temporary. It usually occurs during physical activity, after eating a heavy meal, after being outside when the temperature is below 32° F or above 80° F or during emotional situations.
5 Understanding Your Heart and Common Heart Conditions
Warning Signs
Angina Heart Attack
Symptoms occur with activity or exercise Symptoms may occur with or without and stop with rest activity and do not stop with rest
Chest tightness, pressure, burning—with Chest tightness, pressure, burning—with or without pain—may go to arms or back or without pain—may go to arms or back
Shortness of breath, extreme tiredness, Shortness of breath, extreme tiredness, dizziness, nausea, sweating, heartburn dizziness, nausea, sweating, heartburn
Where Angina Discomfort Can Occur
6 Understanding Your Heart and Common Heart Conditions
Heart Attack The heart muscle heals slowly. Scar tissue forms (Acute Myocardial Infarction) where the heart muscle fibers were damaged and this new tissue may not contract as well as A heart attack occurs when a blood vessel the original tissue. The healthy heart muscle near (coronary artery) that feeds the heart becomes the scarred area has to work harder and, over blocked and cuts off blood flow to the heart time, tiny new blood vessels grow from the muscle (myocardium). This blockage can occur nearby arteries to carry blood to and around from either fatty deposits (plaque), a spasm in the damaged muscle. These little “natural the blood vessel or a clot. bypasses” are called collateral circulation.
A heart attack damages the heart muscle. The Before going home, you and your loved ones damage may be slight or extensive, depending will receive detailed information about your on which blood vessel was blocked and how medications, your cardiac risk factors, and long the blood flow was cut off to the muscle. your activity progression at home. You will be Observance of certain lab results and changes instructed when to follow up with your doctor in your EKG over 24 to 48 hours will diagnose and begin the outpatient cardiac rehabilitation a heart attack. program (see “Lifestyle Changes for a Healthier Heart” section). Your doctor may recommend additional lab work and cardiac testing to determine if further treatment is needed. Your doctor also will prescribe medicines to help reduce your heart’s workload, in order to help the arteries heal and to improve blood flow.
Most patients will have a cardiac catheterization to determine which artery is blocked and have added procedures such as angioplasty, a stent placement or possibly surgery.
During your hospital stay, your health team will monitor you closely, watching for any complications. If they occur, it is usually within a few days after a heart attack.
Common complications are: • Heart rhythm problems • Heart pumping problems or heart failure • Inflammation or swelling around the heart (pericarditis)
7 Understanding Your Heart and Common Heart Conditions
Managing Your Care at Home Returning to sexual activity may be a concern of yours. You may not feel any desire for sexual The healing process has begun. Going home activity at first or you may worry it will trigger is a welcome thought, but fears and concerns another heart attack. Actually, your risk for can accompany it. This is normal. After all, you another heart attack during sex is low. Ask your were monitored closely for several days at the doctor when you can return to sexual activity. hospital and now you will be managing on your In most cases, you can resume when you are own. Your goals for the first two weeks are to able to climb two flights of stairs without chest follow the going home instructions, walk daily pain, shortness of breath or an irregular heart as prescribed and relax. Remember, your body rate. Meanwhile, showing affection with hugs, is adjusting to a new health condition and to caresses and kisses is a good way to get back new medications that may make you feel more in touch with your partner. tired than usual. Having a heart attack is a life-changing event. Sit down, put your feet up and take a nap if you It is a time to become aware of what risk factors are tired. Listen to your body. This is the time to caused the problem and to make appropriate let others help you. Do activities that are easy lifestyle changes (see section on “Lifestyle and enjoyable such as playing games, watching Changes for a Healthier Heart”). movies, reading and just talking. Your doctors and a cardiac rehabilitation Most people do not return to work until after program will guide you on this new journey they have a follow-up visit with the doctor and to wellness. start a cardiac rehabilitation program. Use your progressive walking program (see next page) to guide you with your daily walking and refer to the “Exercising for a Healthier Heart” section in this book for further guidelines. Remember, this lower level of activity is temporary.
It is common for you (and your partner) to feel a wide range of emotions after experiencing a heart attack. Limiting your activities, being out of your normal routine and becoming bored can affect the way you feel. At times, you may find yourself feeling tearful and depressed or you may feel overwhelmed with thankfulness and gratitude. Other common feelings are anger with yourself and those closest to you, discouragement when you don’t think you are improving as fast as you should or just being quietly scared that it will happen again. Express your feelings. Sharing with others can make the road to recovery a lot less bumpy.
8 Understanding Your Heart and Common Heart Conditions
Progressive Walking Program
Your nurse educator will explain a walking program to you before you leave the hospital. You should begin your walking program the day after you come home from the hospital. Use the walking schedule below to chart your progress. If you are walking outdoors, avoid extreme temperatures and walk on level ground, avoiding hills and grades. Please refer to the section on “Exercising for a Healthier Heart” for more guidelines.
Walking Schedule
Dates Time
3 to 5 minutes, ______times a day
6 to 10 minutes, ______times a day
12 to 15 minutes, ______times a day
18 to 20 minutes, ______times a day
25 minutes, once a day
30 minutes, once a day
9 Understanding Your Heart and Common Heart Conditions
Notes:
10 Cardiac Testing
The following is a list of cardiac tests that your or missed beats (palpitations). An EKG doctor may order while you are in the hospital. technician will apply small electrodes on your During any of these tests, if you feel any unusual chest after cleaning your skin with alcohol pads. Men may have some chest hair shaved. The symptoms, such as chest pain, dizziness or electrodes are connected to a small recorder shortness of breath, let your technician know. that you carry with you during the test. After your test is finished, your doctor will review your results with you and decide if any further No special preparation is needed for this test. tests or treatments are needed. Do not take a bath or shower while wearing this monitor, as this could harm the test results. ¨ Electrocardiogram (EKG) You may be given a diary to write down any symptoms that you have while wearing An electrocardiogram is a test that measures the monitor. heart rate and rhythm. It also can measure the type of heartbeat that you are having. ¨ Echocardiogram (Echo) It can show if you are having or have had a heart attack or heart rhythm disturbance. An echocardiogram (echo) uses sound waves to make a moving picture of your heart. This The test is painless and only takes a few test will help evaluate the blood flow, valve minutes to perform. You will need to relax, movement and pumping action of your heart. lie on your back (if able) and tell the technician if you are having any discomfort. An EKG technician will apply small electrodes (sticky pads) on your chest, legs and arms. You will lie still, and the EKG machine will print a copy of your EKG. No special preparation is needed for this test.
¨ Signal Average EKG
This also is an electrocardiogram but may take a little longer for the EKG technician to perform. This test gives more detailed information regarding your heart rate and EKG pattern than a regular EKG. No special preparation is needed for this test. You will lie quietly on a bed and the technician ¨ Holter Monitor (24 or 48 hour) will perform the test. Gel will be applied to your chest, and the technician will gently guide a A Holter monitor is a test that can measure small probe (looks like a microphone) over your heart rate, rhythm and type of heartbeat by chest to obtain pictures. You may feel slight recording your heart’s electrical pattern over pressure on your chest as the technician moves a period of 24 to 48 hours. This test can help the probe. No special preparation is needed by showing any abnormal rhythms, heart rate for this test.
11 Cardiac Testing
¨ Treadmill (Stress Test) Preparation for a stress test: • Some of your medications may be restricted The treadmill test evaluates what your heart before your test. does during activity and if enough oxygen is • Do not eat foods or drink beverages that contain getting to your heart muscle during exercise. caffeine, even if they say “caffeine-free.” Caffeine Heart rate, rhythm and blood pressure is found in chocolate, tea, coffee and soda. are monitored during the entire test. EKG • Your food will be restricted before the test. electrodes (sticky pads) are placed on your • Wear sturdy walking shoes. chest, and a blood pressure cuff is wrapped • Discuss any concerns with the nurse or doctor around one of your arms. You will be asked to performing your test. walk on a treadmill. As you do, the speed and slope will increase. You will probably walk less During and after the test: than 15 minutes, but the total length of the test • Let your doctor or nurse know if you are having may be longer. chest pain, dizziness or other symptoms. • Once you have finished walking, your EKG and blood pressure will be checked for several more minutes while you are resting.
¨ Pharmacological (Drug) Stress Test
If you and your doctor have decided that you are unable to walk for a regular treadmill test, you will lie on a bed in the stress lab. You will receive an IV and be given medication. The medication replaces walking on the treadmill.
Your heart rate, rhythm and blood pressure will be monitored throughout the test. It is important to let your doctor or nurse know if you are having any symptoms, such as chest pain, dizziness or shortness of breath.
You may or may not be able to take all of your medications before the test. You also will have caffeine and food restrictions before the test.
12 Cardiac Testing
¨ Isotope Stress Test ¨ Dobutamine Stress Echo
An IV is started in your arm before your This test combines a pharmacological (drug) treadmill stress test. A chemical called an stress test and an echocardiogram. The isotope (radioactive substance) will be put medication will cause your heart muscle to in the IV during the test. The isotope sticks pump faster, similar to exercise. If you and to your blood cells and will help show images your doctor have decided that you are unable of your heart and how much blood gets into to walk for a regular treadmill test, you will your heart muscle. lie on a bed in the stress lab. You will receive an IV and be given medication. An echo test At the end of your stress test, you will be is performed before the IV is started, as well taken to the Nuclear Medicine department as after the medication is given. This will help to scan pictures of your heart muscle. You your doctor see if there are any changes in will lie quietly on a stretcher with a camera your heart muscle and if your heart is getting overhead. You may be scanned twice with this enough oxygen. procedure, in the same day or two days in a row. If a shadow is seen on your heart muscle You will have some restrictions with medications, picture, it means no blood went to that part food and caffeine before this test. of the muscle. The scan will give your doctor additional information concerning your heart. ¨ Transesophageal Echo (TEE)
You may not be able to take all of your This test is a more detailed echocardiogram. medications before the test. You also will have You will have an IV started and lie in a hospital caffeine and food restrictions before the test. bed. Your throat is sprayed and will be numb. A mild sedative is given and you may sleep ¨ Stress Echocardiogram through this test. (Stress Echo) Your doctor will gently put a small, flexible, This test combines a stress test procedure and lubricated tube into your mouth and down your an echocardiogram. An echo is performed esophagus (swallowing pipe). You’ll be able before and after your stress test. An echo to breathe normally. The end of this tube has test uses sound waves that show your heart’s a small probe that can provide echo images. activity at rest and after exercise. In addition The tube can be moved around slightly to see to the stress test, this will help your doctor see your heart at different angles. You should feel if there are any changes in your heart muscle little or no discomfort with this procedure. Your after exercise. Your doctor will decide if your heart rate, blood pressure and breathing will be heart is getting enough oxygen and if the heart monitored during this test. valves are working properly.
You will have some restrictions with medications, food and caffeine before this test.
13 Cardiac Testing
Preparation for a TEE: an artery in your leg or arm. The catheter • Do not eat or drink after midnight the night before carries dye that is released in a coronary artery the test. so X-ray pictures can be taken to reveal areas • You may take your regular medicines with a small that are clogged or narrowed. The doctor can amount of water (1/4 cup or less) before the test. see, on an X-ray screen, the exact spot where • If you have dentures, they are removed before the the artery is blocked. test is started. The nurse will help you with them after you are awake. The doctor also will be able to measure: • You will not be allowed to eat or drink until the • pressures inside the heart. medicine used to numb your throat wears off. • how well the valves of your heart are working. This usually takes 30 to 60 minutes. • how well the muscle of your heart contracts and • You may not drive yourself home after your test. pumps. This is called an ejection fraction. A normal Before coming for your test, arrange for someone ejection fraction is 50 percent to 70 percent. to take you home afterward.
¨ Tilt Table
The tilt table test checks if changes in your body position affect your blood pressure and heart rate. This test often is given to people who have fainted and may bring back fainting symptoms. • Your heart rate and blood pressure are monitored for any changes. An IV will be started, and you may receive additional medication during the test. • You are placed on a table that is slowly tilted upward, and you will be upright for part of the test. You are held securely in place by large, seatbelt- like straps on the table. • You will have food, caffeine and possibly medication restrictions before this test.
¨ Cardiac Catheterization
A cardiac catheterization (coronary angiogram) is a special test done by a cardiologist to show if the arteries that feed your heart muscle have any blockages. (See “Understanding Your Heart” for a description of coronary arteries.) A soft, hollow tube is threaded up to the heart through
14 Your Heart Medications
Taking your medications as prescribed is an Your Heart Medications important part of keeping your heart healthy. Listed on the next page are common types of It is important for you and your family to heart medications. Before discharge, your nurse understand the reasons for each medicine and will review your medications with you. For more be aware of possible side effects or drug and information, go to the page number listed food interactions that can occur. Many types after each medicine. of medicines are prescribed for heart patients.
After you leave the hospital, your medicines may change. Always make sure you fully understand the changes. It is important to know which medicines to continue and which medicines to stop.
You will be given general information about your medicines. Please consult your pharmacist or physician for more detailed information if you have any questions or concerns.
General Tips on Taking Medicines
• Make sure your heart doctor is aware of all the medications you are taking. This includes medicines from other doctors and over-the- counter and herbal products. • Check with your pharmacist or physician for drug interactions before taking over-the-counter or herbal medicines. • Always carry a current list of medications in your wallet. • Read information that comes with each medicine and know why you are taking it. • Take your medicine exactly as prescribed. • Know whether to take medicines with food or on an empty stomach and if you should avoid any foods. • Be aware of possible side effects of each medication. • Talk to your physician if you have financial concerns about paying for your medicine. • When your medicines are adjusted, make sure you understand the changes.
15 Your Heart Medications
Heart Medicines Prescribed For What They Do Possible Side Effects
ACE-Inhibitors high blood pressure relax blood vessels dry cough, dizziness, and ARB Agents heart failure reduce heart’s drowsiness, sensitivity page 17 heart attack workload to the sun
drowsiness, lighthead- Antiarrhythmics irregular heart rhythms control heart edness or fainting, page 18 rapid heart rate rhythm and rate swelling of hands and feet
angina slow heart rate tiredness, shortness Beta Blockers high blood pressure reduce heart’s of breath, trouble page 19 heart failure workload sleeping, impotence heart attack
Blood-Thinning angina thin blood, reduce stomach irritation, Agents heart failure risk of blood clots unusual bleeding, (including aspirin) heart procedure and heart attack bruising page 20 heart attack
Calcium Channel angina relax blood vessels headache, dizziness, Blockers high blood pressure reduce heart’s swelling of ankles, page 21 heart rhythm problems workload constipation
nausea, loss of Digitalis heart rhythm problems strengthen or slow appetite, confusion, page 22 heart failure heartbeat headache
muscle cramps, reduce blood dry mouth, Diuretics high blood pressure volume by ringing in ears, page 23 heart failure removing excess dizziness or sodium and water lightheadedness
Lipid-Lowering lower the amount muscle pain or Agents high cholesterol of cholesterol soreness, stomach page 24 made by the liver and intestinal upset
Nitrates relax blood vessels (such as headache, lighthead- angina reduce heart’s Nitroglycerin) edness, flushing workload page 25
16 Your Heart Medications
ACE-Inhibitors Side Effects: Dizziness, drowsiness, dry cough, sensitivity Ramipril (Altace) to the sun. Lisinopril (Prinivil, Zestril) Enalapril (Vasotec) Call your doctor if: Captopril (Capoten) Benazapril (Lotensin) • You have swelling of the face, lips, tongue Moexipril (Univasc) or throat—call 911 if you are having Quinipril (Accupril) difficulty breathing. Trandolapril (Mavik) • You develop chest pain. • You develop extreme weakness. Angiotensin II Receptor Blockers • You develop an irregular heartbeat. • You develop yellowing of skin or eyes. Losartan (Cozaar) • You develop a dry cough that continues beyond Valsartan (Diovan) a few days. Candesartan (Atacand) Irbesartan (Avapro) Other changes may occur when using these Olmesartan (Benicar) medications. If you have questions about these Azilsartan (Edarbi) changes, call your doctor or pharmacist.
Combination Food and Drug Interactions: Check with your pharmacist or doctor Lotrel (Benazapril & Norvasc) before taking any over-the-counter cough, Hyzaar (Hydrochlorthiazide & Losartan) cold, allergy, or diet drugs. Check with your pharmacist or doctor before taking any over- Uses: the-counter pain/fever relievers that contain These drugs are used to reduce blood pressure ibuprofen or naproxen (NSAIDs). Tell them (hypertension), and for congestive heart failure about any other drugs you are taking. Ask and kidney disease. them to check for any drug interactions. This medication should be taken with plain Instructions: water. Your doctor may want you to maintain Take this drug exactly as prescribed. Take it a reduced sodium and/or calorie diet. Your at the same time(s) each day. Do not suddenly dietitian can advise you on foods that meet this stop taking this drug without talking to your need. Check with your doctor if you are using doctor. If you miss a dose, take it as soon as a salt substitute. you remember but not if it is within 8 hours of the next dose. If it is within 8 hours, skip the missed dose and resume your usual dosing schedule. Do not take two doses at one time to catch up. Females: Do not take this medicine if you are pregnant or breast-feeding. Notify any physician or dentist that you are on this medication before you have any surgery.
17 Your Heart Medications
Antiarrhythmics Call your doctor if: • You develop hives, itching, rash. Amiodarone (Cordarone, Pacerone) • You develop severe dizziness. Propafenone (Rythmol) • You develop severe nausea. Sotalol (Betapace) • You develop trouble breathing. Multaq (Dronedarone) • You develop irregular heartbeat, slow heartbeat, Tikosyn (Dofetilide) or palpitations. • You develop lower leg swelling or unexplained Uses: weight gain. These drugs are used to slow the heart rate, • You develop chest pain. or to treat ventricular or atrial arrhythmias. • You develop difficulty walking. • You develop blurred vision. Instructions: • You develop unusual bruising or bleeding. Take this drug exactly as prescribed. Take it at the same time(s) each day. Sustained-action Other changes may occur when using these or long-acting tablets or capsules must be medications. If you have questions about these swallowed whole and must not be crushed. changes, call your doctor or pharmacist. Do not suddenly stop taking this type of drug without talking to your doctor. If you miss a Food and Drug Interactions: dose, take it as soon as you remember but Check with your pharmacist or doctor before not if it is within 8 hours of the next dose. If taking any over-the-counter cough, cold, it is within 8 hours, skip the missed dose and allergy, or diet drugs. Tell them about any other resume your usual dosing schedule. Do not drugs you are taking. Ask them to check for any take two doses at one time to catch up. drug interactions.
Count your number of heartbeats per one minute each morning. If your number of heartbeats in one minute is less than 60, call your doctor to check if you should take your medicine.
Side Effects: This medicine may make you feel dizzy or faint, especially if you get up quickly after sitting or lying down. Swelling of hands and feet may occur. You may experience fatigue, constipation or dry mouth. Amiodarone (Cordarone, Pacerone) also may cause increased sensitivity to the sun.
18 Your Heart Medications
Beta Blockers Side Effects: These drugs may make your feet and hands Atenolol (Tenormin, Tenoretic) more sensitive to cold weather. Talk to your Carvedilol (Coreg) doctor if you have a decrease in sex drive Metoprolol (Lopressor, Toprol XL) because the doctor may be able to change Sotalol (Betapace) your medicine. Since beta blockers slow your Bisoprolol (Zebeta, Ziac) heart rate, they may make you feel tired. Bystolic (Nebivolol)
Call your doctor if: Uses: • You are diabetic and have increased episodes These drugs are used to slow the heart of low blood sugar. rate (pulse) and lower blood pressure • You have dizziness when standing up. (hypertension). They can also be used for the • You develop a harsh cough. treatment of angina (chest pain), tremors or • You develop trouble breathing. migraine headaches. These drugs protect your • You develop nausea or vomiting. heart by decreasing the amount of work your • You develop swelling of feet or lower legs, heart has to do. or unexplained weight gain. • You develop chest pain. Instructions: Take this drug exactly as prescribed. Take it at Other changes may occur when using these the same time(s) each day. Sustained-action or medications. If you have questions about these long-acting capsules must be swallowed whole changes, call your doctor or pharmacist. and must not be crushed. Do not suddenly stop taking this drug without talking to your Food and Drug Interactions: doctor. If you miss a dose, take it as soon as Check with your pharmacist or doctor before you remember but not if it is within 8 hours of taking any over-the-counter cough, cold, the next dose. In this case, skip the missed dose allergy, or diet drugs. Tell them about any other and then follow your usual dosing schedule. drugs you are taking. Ask them to check for any Do not take two doses at one time to catch up. drug interactions. This drug can be taken with or without food. Your doctor may want you Count your number of heartbeats for one to maintain a reduced sodium and/or calorie minute before each dose. If your number of diet. Your dietitian can advise you on foods that heartbeats in one minute is less than 60, call meet this need. your doctor to see if you should take your medicine. If it is bedtime and you feel well, you may miss that dose, and call the doctor in the morning.
19 Your Heart Medications
Blood-Thinning Agents Side Effects: Easy bruising, prolonged bleeding. Aspirin Clopidrogel (Plavix) Call your doctor if: Enoxaparin (Lovenox) • You develop an allergic reaction (rash, itching, Warfarin (Coumadin) or hives). Prasugrel (Effient) • You develop bloody diarrhea, tarry stools, blood Ticagrelor (Brelinta) in vomit or urine. Dabigatran (Pradaxa) • You develop swelling of the lips. Rivaroxaban (Xarelto) • You develop trouble breathing. • You develop a sudden severe headache. Uses: These medications are used to • You develop confusion or numbness on the face, prevent and treat heart attacks by preventing arm or leg. blood clots. • You develop chest pain. • You have unusual bleeding or bruising. Instructions: Take aspirin with food to decrease stomach irritation. Take Plavix with a full glass Other changes may occur when using these of water. It can be taken with or without food. medications. If you have questions about these Lovenox, Arixtra and Fragmin are injections. changes, call your doctor or pharmacist. Follow the instructions provided. Food and Drug Interactions: Take at the same time every day. If you miss Check with your physician or pharmacist before a dose one day, do not double your dose the taking any over-the-counter medications that next day. Alert any physician or dentist taking contain ibuprofen, naproxen, or any other NSAID. care of you that you are on this medication. Also check with your physician or pharmacist before taking any over-the-counter herbal Aspirin can cause stomach bleeding, and products. Avoid alcohol as alcohol increases alcohol can make this worse. your risk of bleeding.
A Special Note About Plavix: Warfarin: If you are taking Plavix because you have a Do not change brands of warfarin without drug-coated stent, missing a dose for even consulting your physician. Do not start or stop a few days can cause the stent to become medications, including vitamins and herbs, blocked. Research shows you need to take without double-checking with your physician. Plavix for at least one year after stent placement. Vitamin K-rich vegetables may decrease the If you cannot afford it, discuss this with your effects of warfarin (e.g. spinach, broccoli). Avoid doctor before you stop taking it. drastic changes in diet. Blood tests will be done regularly to adjust your dose.
20 Your Heart Medications
Calcium Channel Blockers Side Effects: This medicine may make you feel dizzy or Diltiazem (Cartia XL, Cardizem, Tiazac) faint, especially if you get up quickly after Verapamil (Calan, Isoptin) sitting or lying down. Swelling of hands and Amlodipine (Norvasc) feet may occur. You may experience fatigue, Nifedipine (Procardia, Adalat CC) constipation or dry mouth. Felodipine (Plendil) Isradapine (Dynacirc) Call your doctor if:
Uses: • You develop hives, itching, rash. • You develop severe dizziness. These drugs are used to slow the heart rate • You develop severe nausea. (irregular heart beat) and reduce blood pressure • You develop irregular heartbeat. (hypertension). They can also be used for the • You develop swelling of feet or lower legs, treatment of angina (chest pain). or unexplained weight gain. • You develop chest pain. Instructions: Take this drug exactly as prescribed. Take it at Other changes may occur when using these the same time(s) each day. Sustained-action medications. If you have questions about these or long-acting tablets or capsules must be changes, call your doctor or pharmacist. swallowed whole and must not be crushed. Do not suddenly stop taking this drug without Food and Drug Interactions: talking to your doctor. If you miss a dose, take it Check with your pharmacist or doctor before as soon as you remember but not if it is within taking any over-the-counter cough, cold, allergy, 8 hours of the next dose. If it is within 8 hours, or diet drugs. Tell them about any other drugs skip the missed dose and resume your usual you are taking. Ask them to check for any drug dosing schedule. Do not take two doses at interactions. Avoid grapefruit juice if taking one time to catch up. felodipine, nifedipine, verapamil, amlodipine.
Count your number of heartbeats per one minute each morning. If your number of heartbeats in one minute is less than 60, call your doctor to check if you should take your medicine.
21 Your Heart Medications
Digitalis Call your doctor if: • You develop confusion. Digoxin (Lanoxin, Lanoxicap, Digitek) • You have blurred vision or see yellow-green halos around objects. Uses: • You develop rapid heartbeat greater than 100 beats This medication strengthens your heartbeat, per minute. controls your heart rate and improves blood • You have a slow heartbeat less than 60 beats circulation. per minute.
Instructions: Other changes may occur when using this Take this drug exactly as prescribed. Take it medication. If you have questions about these at the same time each day. Do not suddenly changes, call your doctor or pharmacist. stop taking this drug or switch brands without talking to your doctor. If you miss a dose, take Food and Drug Interactions: it as soon as you remember but not if it is Many drugs interact with this medicine and can within 12 hours of the next dose. If it is within possibly cause side effects. Check with your 12 hours, skip the missed dose and resume pharmacist or doctor before taking any over- your usual dosing schedule. Do not take the-counter cough, cold, allergy, or diet drugs. double doses. Tell them about any other drugs you are taking. Ask them to check for any drug interactions. Count your number of heartbeats per one This drug can be taken with food or milk to minute each morning. If your number of avoid stomach upset. heartbeats in one minute is less than 60, call your doctor to see if you should take Your physician may periodically check a blood your medicine. level to measure the amount of drug in your blood. This is to monitor for effectiveness Side Effects: and adjust your dose if needed. This drug may cause nausea, vomiting, diarrhea, loss of appetite, drowsiness, headache, muscle weakness or fatigue as your body adjusts to the medication. Confusion, dizziness, vision problems, or changes in heart rate also may occur.
22 Your Heart Medications
Diuretics Side Effects: You may experience dizziness and Loop Diuretics lightheadedness. Rise slowly from a sitting Furosemide (Lasix) or lying position. These drugs may increase Torsemide (Demadex) sun sensitivity. Other effects include nausea, Bumetanide (Bumex) vomiting, diarrhea, rash, muscle cramps, dry mouth, thirst and weakness. Thiazide Diuretics Hydrochlorothizide (Hydrodiuril) Thiazide diuretics can affect blood sugar and Chlorothiazide (Diuril) diabetics may need to adjust medications. Metolazone (Zaroxolyn) Thiazide diuretics can also worsen gout. Spironolactone (Triamterene) These medicines may drive potassium from Uses: your body. Your physician may prescribe a Diuretics are “water pills” that remove excess potassium-rich diet (bananas) or potassium water from the body by increasing urination. supplement. You may need blood tests to Diuretics are used to treat fluid retention monitor your potassium level. and swelling (edema), high blood pressure, congestive heart failure or other conditions Call your doctor if: as determined by your physician. • You develop an allergic reaction, such as hives, rash, itching, or trouble breathing. Instructions: • You develop severe nausea, vomiting or diarrhea Take this drug exactly as prescribed. This (decreases potassium). medication increases the frequency of • You develop muscle cramps (it may be a sign urination. Take the last dose of the day before of low potassium). 6 p.m. If you miss a dose, take it as soon as • You develop severe thirst (dehydration). you remember unless it is almost time for • You have ringing in your ears or hearing loss the next dose. In that case, skip the missed (loop diuretics). dose and take the next one as directed. • You develop weakness or dizziness. Do not take double doses. Food and Drug Interactions: Many drugs interact with these medicines and can possibly cause side effects. Check with your pharmacist or doctor before taking any over-the-counter cough, cold, allergy, or diet drugs. Tell them about any other drugs you are taking. Ask them to check for any drug interactions.
23 Your Heart Medications
Lipid-Lowering Agents Instructions: Take these drugs exactly as prescribed. Statins Extended-release products must not be Simvastatin (Zocor) crushed. If you miss a dose, take it as soon as Pravastatin (Pravachol) you remember unless it is almost time for the Atorvastatin (Lipitor) next dose. In that case, skip the missed dose Lovastatin (Mevacor) and take the next one as directed. Do not take Fluvastatin (Lescol) double doses. Rosuvastatin (Crestor) Vytorin (Zocor & Zetia) Side Effects: Trilipix (Niacin, Lipitor & Tricor) Gastrointestinal side effects are common. These drugs can affect the liver, so periodic Nicotinic Acid blood tests are required. Niacin (Niaspan, Niacor)
Combinations of statins plus either fibrates, Cholesterol Absorption Inhibitor nicotinic acid or ezetimidbe may be beneficial Ezetimibe (Zetia) but can increase the risk of serious muscle pain, and can sometimes lead to kidney failure. Fibrates Gemfibrozil (Lopid) Niacin can cause flushing, tingling or a Fenofibrate (Tricor) sensation of warmth when you first start taking it. These effects usually decrease with Bile-Acid Binding Resins continued use. Colestipol (Colestid) Colesevelam (Welchol) Call your doctor if: • You develop muscle pain or tenderness, especially Fish Oil (Lovaza) if you have a fever or feel fatigued. • You have allergic reactions such as hives, rash, This is general information about lipid-lowering or trouble breathing. agents with a focus on the statins. Please • You develop extreme weakness in your arms consult your pharmacist or physician for or legs. detailed information on a specific product. Food and Drug Interactions: Uses: Many drugs interact with these medicines These medications are used to lower and can possibly cause side effects. Check cholesterol and triglyceride levels when diet with your pharmacist or doctor before taking and exercise alone have not lowered them any over-the-counter cough, cold, allergy, or enough. Reducing cholesterol and triglycerides diet drugs. Tell them about any other drugs helps prevent strokes and heart attacks. Each you are taking. Ask them to check for any class of lipid-lowering agent can be used alone drug interactions. or in combination with another agent.
24 Your Heart Medications
Nitrates Side Effects: Nitroglycerin can cause headaches, dizziness, Isosorbide Mononitrate (Imdur, Ismo, Monoket) flushing, rapid heartbeat, nausea, or vomiting. Isosorbide Dinitrate (Isordil) Headaches are often a sign that the medication Nitroglycerin Patch (Nitrodur, Nitroderm) is working. Treat headaches with Tylenol Nitroglycerin SL Tab (Nitrostat) (acetaminophen). Rise slowly from a sitting Nitroglycerin SL Spray (Nitrolingual) or lying position to prevent dizziness and Nitroglycerine Ointment lightheadedness.
Uses: Call your doctor if: This medication helps relax the blood vessels • You develop a severe headache. and improves blood flow. Nitroglycerin is used • You have dry mouth. to treat chest pain. • You develop a rash. • You have blurred vision. Instructions: • You have new chest pain relieved by nitroglycerine Take these drugs exactly as prescribed. tablets or spray. Extended-release products must not be • You have chest pain not controlled with crushed. If you miss a dose, take it as soon as your medication. you remember unless it is almost time for the next dose. In that case, skip the missed dose Call 911 if you have chest pain unrelieved by and take the next one as directed. Do not take 3 doses (tablet or spray) of nitroglycerine. double doses. Food and Drug Interactions: For tablets under the tongue, at the first sign Do not take Viagra, Cialis or Levita with of chest pain, sit or lie down and place one nitroglycerin. Certain drugs for migraines tablet under your tongue and allow it to and high blood pressure may interact with dissolve. If there is no relief after 5 minutes, nitroglycerin. Do not drink alcohol with this take another tablet. If there is no relief after medication. Check with your pharmacist or 3 tablets, call 911 or have someone drive you doctor before taking any over-the-counter to a hospital emergency room. cough, cold, allergy, or diet drugs. Tell them about any other drugs you are taking. Ask Topical patches are often removed at bedtime them to check for any drug interactions. to allow a drug-free time period. This helps prevent building a tolerance to the drug.
25 Your Heart Medications
Pain Medications Call your doctor if: • You develop a rash. Hydrocodone/Acetaminophen (Vicodin) • You experience trouble breathing. Oxycodone/Acetaminophen (Percocet) • You have trouble urinating. Tramadol/Acetaminophen (Ultracet) • You have ringing in your ears. • You develop depression or hallucinations. Uses: • You have a rapid heartbeat. These medications are painkillers (analgesics). • You develop bloody or dark urine. They contain a combination of a narcotic • You develop yellowish skin or eyes. analgesic and acetaminophen (Tylenol) to treat moderate to severe pain. Food and Drug Interactions: Check with your pharmacist or doctor before Instructions: taking any over-the-counter cough, cold, Take these medications exactly as prescribed. allergy, or diet drugs. Tell them about any other Take only for the condition for which they were drugs you are taking. Ask them to check for prescribed. Do not take more or take for a any drug interactions. longer time than prescribed. Do not take more than 3,000 mg of acetaminophen (Tylenol) Talk to your health care provider if you are per day. Make sure you understand how much taking sedatives, antihistamines, antidepressants Tylenol each pain tablet contains and how or nerve medicines. Do not drink alcohol while many tablets you can take per day. taking this medication, as the combination may cause liver damage. Side Effects: These medications may make you dizzy or With the exception of Tylenol, these medications drowsy. Do not drive or operate machinery are controlled substances. It is illegal to give them unless you are fully alert. They may also cause to anyone else. nausea, vomiting or constipation. Take with food to minimize stomach upset. A stool softener may help relieve constipation.
26 Your Heart Medications
Proton Pump Inhibitors Side Effects: These medications may cause dizziness or Omeprazole (Prilosec) headache. Other rare side effects include rash. Rabeprazole (Aciphex) Notify your physician if this should occur. Lansoprazole (Prevacid) Esomeprazole (Nexium) Call your doctor if: Pantoprazole (Protonix) • You develop a rash. Histamine H2 Blockers • You develop a worsening of your stomach condition. Famotidine (Pepcid) Ranitidine (Zantac) Drug Interactions: Nizatidine (Axid) These medicines may interact with other medications and can possibly cause side Uses: effects. Check with your pharmacist or doctor These medications are used to treat conditions before taking any medication. Tell them about in which there is too much acid in the stomach. any other drugs you are taking. Ask them to They are also used to treat duodenal and check for any drug interactions. gastric ulcers and gastroesophageal reflux disease (GERD).
Instructions: Take these medications exactly as prescribed.
Proton Pump Inhibitors: Best if taken before breakfast (Nexium should be taken 1 hour before breakfast). Swallow the tablet or capsule whole. Do not crush, break, chew or split the tablet or capsule. Capsules may be opened and the granules in the capsule may be sprinkled on a spoonful of cold applesauce or yogurt for immediate use; or you may mix the granules in tap water, apple or orange juice and drink immediately.
Histamine H2 Blockers: Take 30 minutes before a meal and/or at bedtime for best results.
27 Your Heart Medications
Notes:
28 Lifestyle Changes for a Healthier Heart
You cannot change your genetics, but you can Risk Factor Assessment make lifestyle choices that will help your heart to Risk factors are those things that helped create be stronger and healthier. The following pages will your heart disease. You cannot change risk help you to evaluate your controllable risk factors factors such as age, sex, heredity and race. and to take steps to reduce those risk factors in There are risk factors that you can change, your life. You also will learn about our Cardiac however. Making changes to reduce these risk Rehabilitation program, which is designed to put factors can help keep your heart problem from you back on the path to recovery and wellness. getting worse.
Do you currently use tobacco NO YES ______packs per day x ______years (smoke, chew or dip)?
Is your LDL greater than 100, or Total ______Triglycerides ______HDL less than 40 for men and 50 for NO YES L D L ______H D L ______women, or triglycerides over 150?
Have you ever been told you had NO YES high blood pressure?
F r e q u e n c y ______Do you exercise less than 30 NO YES Does it make you sweat? ______minutes a day, three times a week?? Ty p e ______
Do you have diabetes or NO YES metabolic syndrome?
Do you have a family history of F a m i l y m e m b e r ( s ) ______NO YES heart disease, age 55 or younger? ______
H e i g h t ______W e i g h t ______Are you overweight? NO YES Body Mass Index ______(see instructions on page 39)
How would you rank your daily Low High NO YES stress level? 1 2 3 4 5
Do you drink alcohol? NO YES How many drinks/week? ______
Do you have chronic depression? NO YES
The more times you answered YES, the higher your risk for heart disease.
29 Lifestyle Changes for a Healthier Heart
Reducing Risk Factors Tips for Quitting • Make a firm decision to quit and decide on a date Take charge of controllable risk factors: you will quit. • Stop tobacco use • Consider the different cessation aids available: • Reduce high cholesterol 1) Nicotine replacement therapies such as nicotine • Control high blood pressure patches, lozenges, gum, spray and inhalers. Most • Manage diabetes and metabolic syndrome can be found over the counter at your drugstore. • Lose excess weight It is important not to use tobacco products when • Exercise using these aids. • Manage stress • Limit alcohol intake 2) Non-nicotine medicine: buproprion hydrochloride • Seek help for depression (Wellbutrin), which is available by prescription from your doctor. It is an antidepressant that can A Web site that can help you identify and help reduce withdrawal symptoms and the urge take action to reduce your risk factors is to smoke. Another medicine you could try is mylifecheck.org from the American Heart varenicline (Chantix), which is also a prescription Association. medicine. It targets nicotine receptors in the brain and blocks nicotine from reaching them, which Stop Tobacco Use reduces the urge to smoke. Tobacco use is the number-one preventable 3) Alternative therapies such as hypnosis, acupuncture, risk factor for heart disease. This includes relaxation techniques and tobacco-cessation cigarette, cigar and pipe smoking, snuff and classes for behavioral change. chewing tobacco. Quitting is the best thing Contact the TriHealth Fitness & Health Pavilion, you can do for the health of your arteries. 513 985 0900, or a local chapter of the American Lung Association, American Cancer Society or Smoking can cause the heart to work harder American Heart Association. to supply oxygen to your body. It also increases • Make a list of the reasons why you are quitting. your heart rate and blood pressure. The harmful Read the list when you feel like smoking. effects of tobacco use include: • Identify daily routines that trigger your desire to • Damages the lining of the coronary arteries, light up (drinking coffee, driving to work, stressful making blockages worse. situations, being around others who smoke). • Nicotine causes heart rate and blood pressure to Be creative and develop new routines. rise and increases the likelihood that blood clots • Substitute carrot or celery sticks, gum or hard will form. candies, toothpicks, a popsicle, a bottle of water, • Inhaling carbon monoxide which is a poison or brush your teeth when you feel the urge created by smoke. This takes the place of oxygen to smoke. in the blood, which decreases the amount of • Try exercise as a great alternative to smoking. oxygen reaching the heart muscle. • Reward yourself with the money you save. • It cuts 13 to 14 years off your life. • Find a buddy or friend who will quit with you. • Is the most important risk factor for young men Tell people you have quit because the more and women, especially under the age of 50. you say it, the more real it will be for you. • Decreases the ability to exercise. • Decreases HDL which is your good cholesterol.
30 Lifestyle Changes for a Healthier Heart
You may feel discomfort and withdrawal 1 year symptoms as your body rids itself of nicotine. • Risk of coronary heart disease is half that The symptoms will pass in three to five days. of a smoker Cravings may last longer, so stay active to distract yourself and overcome them. Even 5 years if you’ve tried to quit before, don’t give up. • Lung cancer death rate for the average former Many smokers try quitting four to five times smoker (one pack a day) decreases by almost half before they succeed. • Five to 15 years after quitting, stroke risk is reduced to that of a non-smoker What happens after you • Risk of cancer of the mouth, throat and esophagus quit smoking? is half that of a smoker’s
20 minutes 10 years • Blood pressure drops to normal • Lung cancer death rate is similar to that • Pulse rate drops to normal of a non-smoker • Body temperature of hands and feet • Precancerous cells are replaced increases to normal • Risk of cancer of the mouth, throat, esophagus, bladder, kidney, cervix and pancreas decreases 8 hours • Carbon monoxide level in blood drops 15 years to normal • Risk of coronary heart disease is reduced to that • Oxygen level in blood increases to normal of a non-smoker
24 hours • Chance of heart attack decreases Sources: American Cancer Society; 48 hours Centers for Disease Control • Nerve endings start regenerating • Ability to smell and taste improves All benefits are lost by smoking just one cigarette a day, according to the 2 weeks to 3 months American Cancer Society. • Circulation improves • Walking becomes easier • Lung function increases up to 30 percent
1 to 9 months • Coughing, sinus congestion, fatigue and shortness of breath decrease • Cilia (fine, cleaning hairs) regrow in lungs, increasing their ability to handle mucus, clean the lungs and reduce infection
31 Lifestyle Changes for a Healthier Heart
Reduce High Cholesterol Your doctor can calculate your risk of heart disease—low, medium or high. If you already High blood cholesterol is also a major risk have heart disease, or if you have had a heart factor that causes heart disease. Cholesterol procedure, you are considered high risk. can build up in the coronary arteries and Current research suggests that an LDL less cause blockages. The best ways to lower your than 70 may be better for you. cholesterol levels are to lower the amount of fat in your diet, exercise on a regular basis and Methods to increase HDL and lower LDL take your medicines as prescribed. Reducing and triglycerides: your cholesterol is one of the most controllable 1. Stop tobacco use risk factors. 2. Lose weight 3. Exercise regularly Cholesterol is a natural fat-like substance made 4. Manage stress in the liver. Your body makes 75 percent of the 5. Eat a heart-healthy diet cholesterol it needs, so it doesn’t require much 6. Take medicines as ordered by your doctor from the food you eat. Control High Blood Pressure There are two types of cholesterol. Good cholesterol, called HDL (high-density (Hypertension) lipoprotein), does two things: helps remove About 76 million Americans have high blood bad cholesterol from your blood and helps pressure. Many people do not know that they your body to heal when injured or damaged. have high blood pressure because there are HDL prevents plaque from building up in usually no symptoms. That’s why it’s called the the arteries. “silent killer.” Untreated high blood pressure can lead to coronary artery disease (CAD), Bad cholesterol, called LDL (low-density stroke, heart attack, heart failure, kidney failure, lipoprotein), with other substances can form blindness and other medical problems. plaque that can build up in the inner walls of arteries and cause narrowing, which Blood pressure is the force of blood pushing slowly creates blockages. against the artery walls and is recorded in two numbers. The first number is the systolic pressure or the pressure in your arteries when Ideal Blood Levels According to blood is pumped into them. The second the American Heart Association number is the diastolic pressure or the pressure in your arteries when your heart Cholesterol below 200 rests between beats. Triglycerides below 150 HDL above 40 (men) Your blood pressure is determined by taking above 50 (women) the average of three or more readings taken LDL below 70 (high risk) at three different times. A normal blood pressure below 100 (at risk) for a healthy adult is less than 120/80.
32 Lifestyle Changes for a Healthier Heart
A blood pressure of 120–139/80–89 is Manage Diabetes and considered prehypertension. A blood Metabolic Syndrome pressure greater than 140/90 is called high blood pressure, or hypertension. A person Diabetes with diabetes should have a blood pressure When you have diabetes, your body doesn’t under 120/80. do a good job of using the food you eat. This is because it has a problem breaking down carbohydrates. Most of what you eat needs to be broken down into simple sugar, called glucose. Glucose is the body’s main energy source. For glucose to get into your cells, it needs insulin (a hormone made by the pancreas). People with diabetes produce little or no insulin, or the body does not respond to the insulin that is made.
No matter what the cause, glucose builds up in the blood. High blood sugar damages the walls of the artery and narrows the pathway of blood flow. Heart disease may then occur, as well as damage to many other organs including the brain and kidneys. Controlling your blood sugar can help slow or prevent Many of the steps to help lower your blood this damage. pressure also help improve your total health. Here are some things you can do to help A diagnosis of diabetes is made if you have lower your blood pressure. two fasting blood sugars of 126 mg or more. • Stop tobacco use and avoid second-hand smoke. A random blood sugar of 200 mg or more • Exercise 30 minutes a day. also is proof of diabetes. • Eat healthy foods and limit the amount of salt you eat. Metabolic Syndrome • Control your weight—losing as little as 10 to 20 Metabolic syndrome is a collection of health pounds can help lower your blood pressure. risks that increases your chance of developing • Limit alcohol to one to two servings per day. heart disease, stroke and diabetes. Your • Limit caffeine to one to two cups per day. pancreas makes enough insulin but your body • Take your medicine at the same time every day. may have trouble using it. Treatment includes • Seek diagnosis and treatment for sleep apnea; diet and exercise. You also may need to take sleep apnea increases your risk of heart disease. medicine. If you have at least three of the five following symptoms (criteria), you have metabolic syndrome.
33 Lifestyle Changes for a Healthier Heart
Indicators of Metabolic Syndrome Determine If You Have Central Obesity • Central obesity: waist circumference over One way to determine if you have central 40 inches (men); waist circumference over or abdominal obesity is to measure your 35 inches (women) waist in inches across your stomach at the • Triglycerides: above 150 level of your belly button. Women with a • HDL: below 40 for men, below 50 for women waist measurement of 35 inches or bigger, • BP over 130/85, or taking blood pressure medicine or men with a waist measurement of • Fasting blood sugar (glucose) greater than 100, 40 inches or bigger, have central obesity. or Type 2 diabetes A Body Mass Index (BMI) population is also used to determine total body fat. Lose Excess Weight Obesity is linked to many diseases that put BMI is as accurate as waist circumference you at risk for heart disease, diabetes, high in assessing risk of disease. Research shows cholesterol and high blood pressure. Your that as a person’s BMI or waist circumference heart must work harder to supply blood to increases, so does insulin resistance as well the extra weight. The secret to weight loss as triglycerides and higher blood sugar is to eat or drink fewer calories than you burn. concentration in the blood. This means you Diet and exercise can help you do this. If you have a higher risk of developing diabetes are overweight, just a 10 percent weight loss and increased risk of developing heart disease. will help your heart. (See chart on next page.)
Other good reasons for losing weight: • Being overweight takes three years from your life • Being obese takes six to seven years from your life • Obesity plus smoking takes 15 years from your life
34 Lifestyle Changes for a Healthier Heart
Body Mass Index (BMI) Chart Find your height and weight on the chart to determine your body mass index. An ideal range is 19 to 24. A BMI over 25 puts you at risk for high blood pressure, stroke, osteoarthritis, heart disease and certain cancers. A BMI of 25 to 29.9 is considered overweight and a BMI of 30 or higher is considered obese. For people whose BMI may be higher due to large bone structure or greater muscle mass, the waist circumference measurements described on the previous page will help determine whether you are truly at higher risk for serious diseases.
Ht. Body Weight (pounds) (In.) 58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167
59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173
60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179
61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185
62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191
63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197
64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204
65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210
66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216
67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223
68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230
69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236
70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243
71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250
72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258
73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265
74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272
75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279
76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287
BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
Desirable Range Overweight Obesity/Increased Health Risk
35 Lifestyle Changes for a Healthier Heart
Exercise Limit Alcohol Intake
A person who does not exercise has an Drinking more than one to two servings of increased risk of heart disease. Exercising alcohol a day relaxes the heart muscle too just 30 minutes a day will help you to: much and limits the amount of blood the heart • lower your blood pressure feeds itself. When you drink too much alcohol, • raise your HDL (“good”) cholesterol and lower the heart muscle cannot pump or squeeze your total cholesterol and triglyceride levels as strongly. Extra fluid can build up inside the • lower blood sugar (if you have diabetes and heart, causing it to stretch or get bigger. The glucose intolerance) extra pressure on the heart muscle weakens • lose weight the heart, eventually causing congestive heart failure (buildup of fluid in the heart and lungs). Other benefits of exercise include: • lowered stress levels Drinking large amounts of alcohol increases • improved sense of well-being blood pressure, cholesterol and triglyceride • improved quality of sleep levels. This causes atherosclerosis, or • decreased risk of osteoporosis (a disease causing hardening of the arteries. bone to become weaker and more brittle) One serving of alcohol is equal to: Simple ways to increase activity in everyday • 1.5 ounces 80-proof distilled spirits (liquor) life include: • 12 oz. beer or wine cooler • Take the stairs instead of the elevator. • 5 oz. wine • Park farther away from the entrance to your job or stores. There is conflicting evidence about the effect • When you go shopping at the mall, walk for of alcohol on increasing HDL cholesterol levels 10 to 15 minutes before you shop. (the good or protective cholesterol). Some • Incorporate exercise into your housework studies have shown that one serving of alcohol and yard work. per day may increase this level. Other studies • While watching television, stand up and walk have shown that the part of the HDL that is around the room during commercials rather elevated is not the good cholesterol. The than walking to the refrigerator. action of all heart medicines may be changed • Start an exercise routine. Join an exercise group. with drinking alcohol. If you have questions • Find an exercise you like and gradually increase about using alcohol, please discuss this with your activity level. your doctor.
The goal is to exercise for 30 straight minutes, five days a week (preferably daily), to improve your cardiovascular health.
36 Lifestyle Changes for a Healthier Heart
Stress People who successfully deal with stress in their lives feel more relaxed. Some effective Many people try to avoid stress as much as stress management techniques include: possible; others thrive on it. No matter what • exercise you do, stress is unavoidable. Any change, • meditation even positive or good change, brings some • use of guided imagery stress. Stress is the body’s way of dealing with • muscle relaxation change. Once you begin to view stress as a part • listening to music of normal life, you can begin to recognize and • deep-breathing techniques learn to deal with it better. • visiting with friends • taking time to do an activity you enjoy Long-term stress that you do not deal with • reading a book properly may become bad for your health • stress-management class and may help cause heart disease by: • increasing blood pressure The best way to manage stress is to practice • increasing heart rate healthy habits such as eating a nutritious diet, • increasing cholesterol levels exercising, avoiding alcohol and drugs and • increasing blood sugar levels getting six to eight hours of sleep each night.
Some possible symptoms of stress are: Cardiac Rehabilitation • irritability • bowel problems Our Cardiac Rehabilitation program guides you • tense muscles in the jaw, neck and shoulders in making lifestyle changes that will help your • depression heart. The purpose of cardiac rehabilitation • mood swings is to help people return to everyday life. An • sleep problems important goal is to prevent a heart attack and • stomach problems halt or slow disease progression. Cardiac rehab focuses on these main areas: • exercise to make you stronger • education about your heart problem • advice on healthy habits • assistance with making life changes, such as losing weight or quitting smoking • counseling to help you cope with depression and learn how to deal with stress
The patients in the program will be a lot like you. Anyone with heart disease, regardless of age, will benefit from cardiac rehab.
37 Lifestyle Changes for a Healthier Heart
People who go to cardiac rehab include At each session, you will be monitored closely those who have had heart disease such as by a cardiac rehab nurse and an exercise angina or heart failure; a recent heart attack; physiologist. A personal exercise plan will be recent heart surgery; cardiac intervention developed based on your needs, abilities and such as balloon angioplasty or stent goals. These exercise classes are fun, upbeat placement; or a heart transplant. and slightly challenging.
The Three Phases of Group classes and individual education play Cardiac Rehabilitation a big role in the Phase II program. Weekly educational classes also are offered. We Phase I – Inpatient encourage your family members and friends While you are in the hospital, the Phase I nurse to attend these classes. (heart educator) may see you and your family. This education starts after you have been Class topics include: treated for a heart problem. The nurse will • Heart disease teach you about your specific heart condition • Blood pressure management and risk factors that caused your heart disease. • Lifestyle changes and goal setting You will be given written material. • Nutritional counseling • Stress management You may watch a video or attend a class about • Exercise guidelines your heart problems and treatments. The • Weight management Phase I nurse also will explain the outpatient Phase II cardiac rehab program, which is Goals for Phase II: designed to help your heart get healthy again • Improve your energy level by strengthening your and help you reduce your risk factors. You will heart with exercise receive written information regarding entry into • Provide education about lifestyle changes that will a program. keep your heart healthy • Reduce the fear and anxiety about increasing your Phase II – Immediate Outpatient activities and exercise After allowing your heart some time to heal, • Assist you in making social, emotional and you will see your doctor and get a referral psychological adjustments to your heart disease to start Phase II of cardiac rehab. This usually and lifestyle changes happens two to six weeks after leaving the hospital, depending on your condition and recovery. The program covers 36 one-hour sessions over 12 weeks (Monday/Wednesday/ Cardiac Rehabilitation at the TriHealth Fitness Friday). Check your insurance policy for & Health Pavilion 513 985 6776 coverage before attending a cardiac rehab Good Samaritan Hospital Cardiac Rehabilitation program. Most insurance policies will cover Program 513 862 2837 hospital-affiliated outpatient programs.
38 Lifestyle Changes for a Healthier Heart
Phase III – Maintenance Program The Cardiac Rehab Team Phase III of cardiac rehab is a supervised exercise program that is available to those You are the most important member of who complete Phase II. This phase teaches the team! Your commitment to take care independent exercising without a monitor. of yourself is the key to your recovery and It is available to you for as long as you ongoing heart health. The cardiac rehab team choose to participate. It is not typically involves health care providers who are trained covered by insurance. to guide your recovery. Your team includes: • you Goals for Phase III: • your family • Create an ongoing exercise program • doctors (your family doctor, cardiologist • Offer support necessary for lifestyle changes and/or heart surgeon) • Assist you in reaching goals such as independent • cardiac nurses living and/or returning to work • exercise physiologists • Prevent or slow the progression of heart disease • dietitians
Coming back after a heart attack, heart surgery or a diagnosis of heart disease can be challenging for many reasons. Take advantage of the program classes and work with your health care team to design your own plan to lead a healthier life.
39 Lifestyle Changes for a Healthier Heart
Notes:
40 Eating with Your Heart’s Consent
Your doctor wants you to improve your heart The Diet-Heart Connection health by eating foods low in cholesterol, fat Cholesterol is a waxy material that all animals (especially saturated fat), and sodium. Making make and store. Your body needs it to make healthy food choices can be an important way certain hormones. It also is used for building to lower blood pressure, weight and cholesterol cells. If your blood cholesterol level is high, levels. The guidelines in this booklet are a first you are more likely to develop atherosclerosis, step toward accomplishing these goals. a buildup of fatty substances along your artery walls. You cannot control the amount of Make a Change and Take It to Heart cholesterol your body makes, but you can limit the cholesterol you take in from animal Changing your diet and sticking with the products. If you lower the amount of cholesterol changes can be difficult. It is easier if you in your body, you may be able to slow down make changes slowly. It may take several or prevent atherosclerosis. There are changes months of diet and lifestyle changes to see you can make in your diet that might help: a drop in your blood cholesterol levels. • Lose weight if you are overweight. • Limit your sodium intake. You will want to resist going back to your • Eat less fat, especially saturated fat. old lifestyle and eating habits so you do not • When you have to use fat for cooking, lose the progress you have made. By sticking use an unsaturated fat (monounsaturated with new eating habits, you will help your or polyunsaturated). heart—and the rest of your body. The following • Eat fewer high-cholesterol foods. information will explain why you should eat • Eat more whole grains, vegetables and fruits. certain foods and not others. Lose Weight if You Are Overweight If you follow your diet closely on most days, you usually can eat small amounts of food If you weigh more than you should, your high in fat or cholesterol for special occasions. dietitian can help you find ways to lose weight The same is true for food high in sodium safely. Fad diets are not the answer. Fast weight unless you have congestive heart failure or loss is not good for your health. You should kidney disease. In those cases, you always not lose more than one to two pounds a week. should avoid high-sodium foods, since they In most cases, you should not try to lose weight can cause serious problems. before or right after surgery.
Your dietitian can help you make changes You may not need a special weight-loss in your diet. If your cholesterol still does diet. If you eat less fat and smaller portions not come down after making healthier of food, you will take in fewer calories and food choices, or if you already have heart lose some weight. disease, your dietitian may have some special recommendations. If you are taking cholesterol-lowering medication, diet works with the medicine to help bring your cholesterol levels down.
41 Eating with Your Heart’s Consent
Limit Your Sodium Intake You may find that foods taste bland until you get used to less salt. Try adding herbs and Sodium is a mineral that helps control the spices to foods. Try mixing different flavors like amount of water in your body. Too much chicken with orange sauce or meatloaf with sodium can cause your body to hold extra pineapple. There are two major types of salt fluid. This may affect your blood pressure. substitutes available. One is a mixture of herbs It also makes the heart work harder. This can and spices. Another is made with potassium be a problem if the heart already has been chloride either by itself or mixed with other damaged by atherosclerosis. ingredients and spices. Check with your doctor before using any salt substitute made with People with heart problems and high blood potassium chloride. pressure should eat less sodium. Sodium is found in everything you eat. The amount Salt-Free Seasoning Ideas found naturally in fresh fruits, fresh vegetables You can add flavor to food without adding salt. and fresh meat usually is not a concern. Most Studies have shown that after 8 to 12 weeks of the sodium in your diet comes from the on a lower-sodium diet, people actually prefer sodium that is added when food is processed less salty foods. and from salt you add to your food (salt is made of sodium and chloride). Start with these ideas and create your own combinations to suit your taste. If you use The American Heart Association recommends fresh herbs instead of dried herbs, use twice limiting sodium to less than 1,500 milligrams the amount. per day. However, that may be difficult for most people to follow at first; you can start reducing the amount of sodium in your diet by not adding extra salt at the table. You also can reduce the amount of salt you add when cooking.
In addition, try to eat fewer processed foods. Salted snack foods, processed meats (such as hot dogs, lunch meats and sausage), canned soups and frozen dinners tend to be high in sodium. Instead, choose low-sodium soups and reduced-sodium frozen dinners. If you have certain health problems such as congestive heart failure, you may need to follow a stricter low-sodium diet.
42 Eating with Your Heart’s Consent
Salt-Free Seasoning for Meat, Fish Salt-Free Seasoning for Vegetables and Poultry
bay leaf, dry mustard garlic or garlic powder, powder, green pepper, Asparagus lemon juice, onions marjoram, fresh or vinegar Beef mushrooms, nutmeg, dill, ginger, honey, onions or onion powder, Carrots pepper, sage or thyme marjoram, mint or thyme
green or red pepper, green pepper, lemon Corn juice, marjoram, fresh nutmeg or fresh tomato Chicken mushrooms, paprika, parsley, poultry seasoning, Cucumbers chives, dill, garlic or vinegar sage or thyme lemon juice, marjoram, bay leaf, curry powder, Green beans nutmeg, pimiento or dill, dry mustard powder, sweet basil Fish green pepper, lemon onion or onion powder, juice, marjoram, onions Greens pepper or vinegar or paprika green pepper, mint, curry powder, garlic Peas fresh mushrooms, onion or garlic powder, mint, Lamb or parsley mint jelly, pineapple or rosemary dill, green pepper, mace, Potatoes onions, paprika or parsley apple, applesauce, Pork garlic or garlic powder, brown sugar, cinnamon, onions or sage Squash ginger, mace, nutmeg or onion bay leaf, curry powder, Veal ginger, marjoram or basil, marjoram, onions Tomatoes oregano or oregano
43 Eating with Your Heart’s Consent
Eating From the Major Food Groups Eat Plenty of Fruits, Vegetables and Grains Fruits, vegetables and whole grains taste good On the following pages you will find charts and are good for you. They are full of vitamins listing many common foods. The foods are and minerals and other natural ingredients listed in three columns, showing how you that your body needs. They can help fill you should use them in your diet. Use these up because they are high in fiber. Some kinds charts to help you make your food choices. of fiber also may help lower your cholesterol If you do, your diet should fall within heart- level. Gradually increase the fiber in your diet healthy guidelines: by choosing whole-grain cereals, whole-grain • no more than 30 percent of calories are from fat breads, fruits, vegetables and dried beans. Set • no more than one-third of total fat is saturated a goal of gradually increasing your fiber intake • no more than 200 milligrams of cholesterol to 20 to 35 grams of fiber per day. • sodium restriction of no more than 2,000 milligrams per day There are two types of fiber found in foods: soluble and insoluble. Soluble fiber binds Foods in the Good Choices column are very with cholesterol and removes it from the low in fat, cholesterol and sodium. Unless you body. Some foods high in soluble fiber include are on other diet restrictions, you can eat these apples, broccoli, dried beans, lentils, oatmeal, foods every day. pears and raisins.
Foods in the Use in Moderation column contain Insoluble fiber (“roughage”) adds bulk to stools some fat and cholesterol. Many of these foods and helps prevent constipation and promotes are an important part of a heart-healthy diet. regularity. Foods high in insoluble fiber include You can use them, but you need to limit the bran cereals, cauliflower, fruits and vegetables portion or how often you eat them. with edible skins, dried beans and peas, nuts and seeds. Foods in the Avoid column should not be a regular part of your diet. They are either very high in fat, cholesterol or sodium. Limit food choices from this group to twice a month— Caution: Be careful when you add fiber to your less is even better. diet. You may have cramping, gas and diarrhea if you suddenly eat large amounts of fiber. Add Foods that are marked with an “*” are high high-fiber foods to your diet slowly. in sodium but are low in fat or cholesterol. In addition to eating good foods, drink 8 to 10 glasses of water or fluids each day. Drinking water helps prevent constipation and keeps your body hydrated.
44 Eating with Your Heart’s Consent
Bread, Cereal, Rice and Pasta Each serving in the first column contains: 80 calories, 3 grams protein 6 to 9 servings per day 15 grams carbohydrate Suggested serving size: 1 gram fat 1 slice bread (1-ounce slice) 1/2 cup rice, pasta (cooked) 4 to 6 soda crackers 1/2 cup starchy vegetables, cooked
Good Choices Use in Moderation Avoid
Bread Egg noodles Bread White, wheat, rye, (limit to 1/2 cup per day) Egg or cheese breads French, Italian, raisin, Croissants pumpernickel Graham crackers Biscuits, muffins and corn Bagels (made without egg) Soda crackers, unsalted bread made with whole Plain dinner rolls milk or whole eggs Buns, hamburger or hot dog Biscuits, muffins, pies, Butter rolls Tortillas, corn or flour (made cakes, corn bread and Tortillas made with lard without lard, not fried) cookies, made with or other saturated fat Fat-free tortillas allowed ingredients** Self-rising flour* Cereal (with no more than 3 Cereal Cooked cereal grams of fat per serving) Cereal made with Dry cereal (except those chocolate, nuts made with fat, coconut Low-fat granola cereals or coconut or chocolate) Granola cereals Grains/Rice/Pasta Grains/Rice/Pasta Rice, white or brown Pasta and rice mixes Bulgar made with animal Barley fat, hydrogenated fat Pasta (spaghetti, macaroni, or a lot of sodium rotini, etc.) Stuffing mixes Noodles (made without egg) Crackers/Snacks Crackers/Snacks Snack crackers high in Angel food cake salt and fat (especially Pretzels, unsalted saturated fat) Popcorn (made without Fried snack foods salt or fat) (chips, etc.) Melba Toast Egg matzo Matzo (made without egg) Donuts and sweet rolls Fat-free crackers that Cakes, pies, cookies and are low in salt, or have other baked products “unsalted tops” that are high in fat or made with eggs, butter or whole milk products
*High in sodium but not high in fat. **Look for good and moderate choices under “Fats” on page 52. 45 Eating with Your Heart’s Consent
Vegetables
3 to 5 servings per day Suggested serving size: 1 cup raw leafy vegetables 1/2 cup other vegetables, cooked or raw
Each serving in the first two columns contains: 25 calories, 2 grams protein 5 grams carbohydrate 0 grams fat
Good Choices Use in Moderation
Fresh, frozen (plain) or Onions Unrinsed regular canned canned (unsalted, “no salt Parsnips vegetables* added” or rinsed): Peas** Regular tomato sauce* Artichoke Peppers Spaghetti sauce (check Asparagus (green, red, orange, yellow) labels for fat content Bamboo shoots Potatoes** since they vary by brand) Beans (green or wax) Radishes Beets Rutabagas Broccoli Snow peas (pea pods) Brussels sprouts Sprouts Cabbage Squash, pumpkin Carrots Sweet potatoes** Cauliflower Tomato Avoid Celery Tomato or vegetable juice, Corn** tomato sauce (unsalted Sauerkraut* Cucumbers or no salt added) Pickles* Eggplant Water chestnuts Vegetables made in brine Greens (spinach, beet, kale, Zucchini (salt water)* turnip, collard, mustard, Vegetables made with dandelion, Swiss chard) butter, cream, eggs, meat, Lettuce fat, bacon or other Lima beans** ingredients to be avoided Mixed vegetables Regular tomato or Mushrooms vegetable juice* Okra
*High in sodium but not high in fat. **Starchy vegetables are higher in calories and carbohydrates. 46 Eating with Your Heart’s Consent
Fruit
2 to 4 servings per day Suggested serving size: 1/2 cup unsweetened juice or canned fruit 1 medium piece of fresh fruit 1 cup diced melon 2 pieces dried fruit
Each serving in the first two columns contains: 60 calories, 0 grams protein 15 grams carbohydrate 0 grams fat
Good Choices Use in Moderation
Fresh, frozen, canned Papaya Avocados Apple/apple juice/ Peach/peach nectar apple cider Pear/pear nectar Applesauce Persimmon Apricot/apricot nectar Pineapple/pineapple juice Banana Plums Blackberries Pomegranate Blueberries Prunes/prune juice Boysenberries Raisins Cantaloupe Raspberries Casaba melon Rhubarb Cherries Strawberries Cranberries/cranberry juice Tangerine Avoid Dates Tangelo Figs Watermelon Coconut Fruit cocktail Grapefruit/grapefruit juice Grapes/grape juice Guava Honeydew melon Kiwi Mandarin oranges Mango Nectarine Orange/orange juice
47 Eating with Your Heart’s Consent
Why You Should Limit Foods With Fat A few vegetable oils have a high natural The amount and kind of fat in your diet affects saturated fat content. Coconut oil, palm how your body makes and uses cholesterol. and palm kernel oil and cocoa butter (found Large amounts of any fat, especially saturated in chocolate) are saturated. Saturated fat fat, tend to raise your cholesterol. Unsaturated should be limited to 10 grams per day. fats (monounsaturated and polyunsaturated) may help control it. Transunsaturated fats (or “trans fats”) form when vegetable oils are processed into stick Try to limit the total amount of fat in your margarine or shortening. This type of fat should diet to 25 to 35 percent of your calories be limited in the diet. Snack foods and baked by using the guidelines in this section. Use goods made with “partially hydrogenated monounsaturated and polyunsaturated fat vegetable oil” or “vegetable shortening” are when you need to use fat, but use as little sources of trans fats. Other sources of trans as possible. No more than one-third of your fats include crackers, cookies, French fries, fat should be saturated. Watch out for hidden fast foods and fried foods served at restaurants. fat. Fried foods, mayonnaise, dessert toppings, Read and compare labels to find margarines sauces, gravies and fat in baked goods all that have the least amount of saturated fat can add too much fat to your diet. and trans fats. Choose tub or liquid margarine, or trans fat-free spreads. Use olive oil or canola Unsaturated Fat oil when cooking. Monounsaturated and polyunsaturated fats may help control your cholesterol level. Eat Fewer Foods Containing Cholesterol These fats are liquid at room temperature. Cholesterol is found only in foods made with Most vegetable oils are unsaturated. Olive meat, poultry, fish, eggs, dairy or other animal oil, peanut oil and canola oil are good sources products. You still can enjoy many of them of monounsaturated fat. Safflower, sunflower, if you watch your serving sizes and select corn, soybean and flaxseed oils are good animal products that are lowest in cholesterol sources of polyunsaturated fat. and fat. Often, animal products that are high in fat also are high in cholesterol (like butter, Saturated Fat cheese, gravy and fatty meats, such as steak). Saturated fats can raise cholesterol levels in There also are some high-cholesterol foods the blood. They are solid at room temperature. that are not high in fat. Examples are egg Animal fats tend to be high in saturated fat. yolks, shrimp and organ meats (liver, brain Trim fat from your meat. Remove skin from and kidneys). Limit meat to 6 ounces per day. chicken and turkey. Eat smaller portions of meat. Try to avoid high-fat animal products There is no danger of getting too little such as butter, lard, gravies, sauces and whole cholesterol in your diet. Your liver makes milk dairy products. as much cholesterol as your body needs and sometimes more.
48 Eating with Your Heart’s Consent
Milk, Yogurt and Cheese Each serving in the first column contains: 90 calories, 8 grams protein 2 to 3 servings per day 12 grams carbohydrate Suggested serving size: 1 gram fat 1 cup skim or fat-free milk
Good Choices Use in Moderation Avoid
Milk Milk (no more than 4 ounces Milk Skim milk per day selected from Whole milk 1/2% milk the following) Buttermilk made from 1% milk 2% milk whole milk Canned evaporated Buttermilk made from Canned evaporated whole milk skim milk low-fat or skim milk* Condensed milk Skim milk powder (nonfat Canned evaporated Eggnog dry milk) low-fat milk Imitation or filled milk Yogurt, nonfat (plain Yogurt made from Yogurt made from whole milk or with fruit) low-fat milk (plain, Cream (light, coffee, whipping) Fat-free puddings with fruit, frozen) Half-and-half Frozen desserts with 0 to 2 Milk Drinks Sour cream grams of fat per serving Cocoa made with low-fat Milk Drinks (such as yogurt, ice milk, milk and cocoa powder Drinks made with whole milk or fat-free ice cream) Milk Desserts (malts, milk shakes, lattes, Fat-free sour cream Homemade custard and cappuccino, etc.) Fat-free half-and-half (such pudding made with Cocoa made with whole milk, as Land O’ Lakes brand) low-fat milk and amount chocolate or cocoa butter Fat-free coffee creamers of egg allowed (homemade or instant) Fat-free and low-fat cheeses Frozen desserts with Milk Desserts with 1 gram of fat or less 3 to 5 grams of fat per Custard and pudding made per serving serving size (such as with whole milk or more low-fat ice cream or eggs than allowed low-fat frozen yogurt) Ice cream, ice milk or other Low-fat or reduced-fat sour frozen desserts made with cream with no more than cream, coconut or palm oil, 3 grams of fat per serving other restricted ingredients, Cheese or containing more than Cheeses having between 5 grams of fat per serving 2 to 5 grams of fat per Cheese serving (such as low-fat Cream cheese cottage cheese,* part skim Cheese with more than milk cheese, feta cheese, 5 grams of fat per serving farmer’s, mozzarella, Specialty cheese neufchatel) containing sausage
* High in sodium but not high in fat
49 Eating with Your Heart’s Consent
Meat, Poultry, Fish, Dried Beans, Eggs and Nuts
No more than 5 to 6 ounces per day. Trim off fat before cooking. Bake, broil, microwave, roast or grill meat without adding extra fat. Limit beef and pork to 2 servings per week.
Each serving in the second column contains: 55 calories, 7 grams protein 0 grams carbohydrate 3 grams fat
Good Choices Use in Moderation Avoid
These have 1 gram of fat Even though these are These have more than or less per serving and less good choices, portions 5 grams of fat per ounce than 1 gram of saturated fat. must still be limited. They (with more than 2 grams They also are low in sodium. have between 2 and 5 grams saturated fat) or are high of fat per ounce and up in cholesterol or sodium. Egg whites to 2 grams of saturated fat. Egg substitutes with Seafood no cholesterol Seafood Roe, caviar Dried beans, peas, lentils Fish (plain), fresh or frozen Anchovies, sardines Fish, canned in water, rinsed Fish canned in oil Shellfish (clams, crab, Fried fish oysters, lobster, shrimp, Breaded frozen fish scallops) not fried and Poultry not served with “Avoid” Duck ingredients on page 52 Goose Poultry Squab White meat if possible, Poultry skin no skin Veal Cornish hen Breast Chicken Commercial ground veal Turkey, fresh, frozen, Pork ground breast Bacon Game Boston butt Rabbit Commercial ground pork Squirrel Rib chops Venison (lean) Sirloin roast Spareribs Sausage, bratwurst, metts
50 Eating with Your Heart’s Consent
Meat, Poultry, Fish, Dried Beans, Eggs and Nuts (Continued)
Good Choices Use in Moderation Avoid
You do not have to give Veal Beef up meat entirely, but watch Cutlets Any well-marbled meat the portions you eat. Aim Leg (round, rump) Brisket for 3-ounce servings. Loin (roast, chops, sirloin) Corned beef Ribs (chops, steaks) Rib roast, rib steak It is OK to eat red meat Shanks Club steak occasionally. Aim for Shoulder (roast, steak, breast) Porterhouse steak 2 servings per week, Pork T-bone steak 3 ounces each serving. Ham (lean center slices)* Commercial ground beef Choose lean meats. Loin (chops, roast) or hamburger Tenderloin Processed Meat Eat heart-healthy fish such Beef Regular cold cuts, hot dogs, as salmon, tuna, mackerel Ground beef, lean luncheon/deli meats and lake trout 2 to 3 times (from round or sirloin) Light or reduced-fat meats a week, in 3- to 4-ounce Roasts (sirloin tip, round, or hot dogs with more servings. rump, arm) than 5 grams of fat Steaks (flank, shoulder, per ounce round, tenderloin) Lamb Chipped beef Breast Processed Meat Commercial ground lamb Luncheon/deli meats and Organ Meats hot dogs with no more Liver than 5 grams of fat Kidney per ounce* Brain Lamb Heart Roast and steak (leg) Tongue Chops (loin, rib, shoulder) Miscellaneous Eggs Frozen, prepared meat Whole eggs or egg yolk and entrée items with (no more than 2 to 4 more than 7 grams per week, including those of fat per serving used in cooking) Miscellaneous Tofu (soybean curd) Peanut butter (limit to 1 tbsp. daily) Nuts, unsalted (limit to one small handful a day) Soy meat substitutes, such as Garden burgers, Boca burgers, etc.
* High in sodium but not high in fat
51 Eating with Your Heart’s Consent
Fats Each serving in the second and third columns contains: No more than 6 to 8 teaspoons per day 45 calories, 0 grams protein (This includes any fat used in processing 0 grams carbohydrate or preparing food.) 5 grams fat Suggested serving size: 1 tablespoon regular salad dressing 1 teaspoon margarine, oil, mayonnaise 1 tablespoon nuts and seeds
Good Choices Use in Moderation Avoid
These items have less than These items have up to These items have the same 2 grams of fat per serving 5 grams of fat per serving amount of fat as items in the and less than 1 gram but less than 1 gram of second column, but they of saturated fat. saturated fat. are higher in saturated fat.
Fat-free fat substitutes Oils (Monounsaturated) Oils (such as Butter Buds Olive oil Coconut oil and Molly McButter) Canola oil Cocoa butter Fat-free mayonnaise, Peanut oil Palm and palm kernel oil margarine, cream cheese, Oils (Polyunsaturated) Hydrogenated oil salad dressing, sour Sunflower seed oil Fats cream, coffee creamer Safflower oil Butter Salad dressings with less Corn oil Margarine made with a high than 2 grams of fat Soybean oil percentage of saturated per serving* Sesame seed oil fat or made with animal Fat-free whipped topping Cottonseed oil fat (lard or butter) Flaxseed oil Vegetable shortening Margarine Roquefort, Bleu cheese (first ingredient listed or other salad dressings is liquid vegetable oil) made with fats to avoid Mayonnaise with 2 to 5 Sour cream grams of fat per serving Imitation sour cream made (and made with one of with fats in this column the oils listed above) Cream (light, coffee, Nondairy creamers made whipping, nondairy with one of the oils listed whipped topping) above (such as Poly Rich)
* High in sodium but not high in fat
52 Eating with Your Heart’s Consent
Fats (Continued)
Good Choices Use in Moderation Avoid
Use unsaturated oil Low-fat sour cream with Creamers containing or monounsaturated no more than 3 grams coconut and/or palm oil fats when baking. of fat per serving Half-and-half Reduced-fat cream cheese Cream cheese (containing When baking a cake, Nuts & Seeds 5 or more grams of fat substitute applesauce, Nuts, unsalted—almonds, per serving) baby food prunes walnuts, peanuts, pecans Lard, bacon, bacon fat, or pureed prunes (limit to 1 tablespoon daily) salt pork for cooking oil. Seeds, unsalted—sesame, Chicken fat sunflower (limit to 1 Beef fat, suet tablespoon daily) Chitterlings Coconut milk Nuts Cashews Pistachios Macadamia nuts
53 Eating with Your Heart’s Consent
Miscellaneous
Good Choices Use in Moderation Avoid
Beverages Beverages Beverages Decaffeinated drinks (tea, Alcoholic beverages only Gatorade or other coffee, soft drinks, fruit with doctor’s permission “energy” drinks* drinks, Postum) Caffeinated drinks, if allowed Any beverage containing Soups by doctor (coffee, tea, soft ingredients to avoid** Fat-free, low-salt broth drinks that contain caffeine; Soups or bouillon cocoa if made with allowed Regular canned, dried Soups made with allowed ingredients)** or dehydrated soups ingredients Seasonings, Sauces Soups containing Candy, Sugar & Desserts & Condiments ingredients to avoid*** Fat-free baked desserts Catsup, mustard (limit Candy & Desserts Hard candies to 1 tablespoon daily)* Candy or desserts Gum drops Sauces such as soy, steak, made with chocolate Marshmallows BBQ, Worcestershire (limit or coconut Plain sugar candies to 1 teaspoon daily)* Caramels or candy made Jam, jelly, marmalade Salt substitutes made with with butter or cream Sugar, sugar substitute potassium chloride should Cakes, pies, cookies, frozen Honey, molasses, syrups only be used with doctor’s desserts made with Gelatin permission ingredients to avoid*** Sherbet, fruit ices Medications Seasonings & Sauces Angel food cake, meringues Antacids or laxatives Seasoning salt* Seasonings & Sauces made with sodium Monosodium glutamate* All herbs and spices made (check with doctor) Hollandaise sauce and without salt other sauces containing Vinegar fat or other ingredients Liquid Smoke listed under “Avoid”*** Canned gravy, sauces or instant mixes Meat tenderizer containing sodium* Salt, sea salt, Kosher salt
*High in sodium but not high in fat. **See guidelines under “Milk,” page 49. ***Look for good and moderate choices under “Fats,” page 52. 54 Eating with Your Heart’s Consent
The Mediterranean Diet You may wish to include some of these guidelines in your heart-healthy diet. Choose For an even stricter heart-healthy diet, many plenty of fruits and vegetables—five to eight heart specialists and dietitians recommend servings per day. Consider including vegetarian a Mediterranean-style diet emphasizing more meals in your diet. Choose brown rice, whole- vegetables and olive oil and less meat. Research wheat pasta and whole-grain breads. Make a has shown that people who live in countries stir-fry using a variety of vegetables and a small that border the Mediterranean Sea tend to have amount of meat. Drink six glasses of water per lower rates of heart disease. This may be due, day unless your doctor recommends otherwise. at least in part, to foods traditionally eaten in this part of the world, though other lifestyle For more information on the Mediterranean differences exist as well. diet go to the American Heart Association Web site: www.heart.org. While each country has its own culture, ethnic background, traditions and agricultural production, there are similar patterns to their traditional diets: • Diet is high in fruits, vegetables, nuts, seeds, beans, whole-grain breads and whole-grain cereals. • Olive oil is used as the major fat source in the diet (olive oil is high in monounsaturated fat). • Dairy products, fish and poultry are eaten in small amounts and only a few times per week. • Red meat is eaten very infrequently (a few times per month) and in very small amounts. • Eggs are eaten infrequently (zero to four times per week). • Red wine is consumed in low to moderate amounts (check with your doctor before drinking any alcoholic beverages, even in moderation). Purple grape juice offers the same health benefits of red wine but without the alcohol.
55 Eating with Your Heart’s Consent
Seven Ways to Size Up Your Servings
Measure food portions so you know exactly how much food you are eating. When a food scale or measuring cups are not handy, you can still estimate your portion. Remember:
3 ounces of meat is about the size and thickness of playing 1 cards or an audiotape cassette.
A medium apple or peach is 2 about the size of a tennis ball.
1 ounce of cheese is about 3 the size of 4 stacked dice.
1/2 cup of ice cream is about the size of a 4 racquetball or tennis ball.
1 cup of mashed potatoes or broccoli is about the size 5 of your fist.
1 teaspoon of butter or peanut butter is about the 6 size of the tip of your thumb.
1 ounce of nuts or small 7 candies equals one handful. 1 oz.
56 Eating with Your Heart’s Consent
Eating Out Appetizers Choose fruit, fruit juice, fresh vegetables with Choose foods with care when eating out. low-fat dip or salad with low-fat or fat-free Often you can ask for foods that are not dressing. Avoid cheeses, fried foods or high-fat on the menu (such as skim milk, or margarine dips and spreads. instead of butter). You also can ask for food to be made with no extra fat or salt. Remember, Soups and Salads just because a portion is large or an item Choose plain fruit salads, gelatin salads or comes with the food ordered (such as gravy, vegetable salads. Use fat-free dressing or a sauces and whipped toppings) does not mean small amount of regular oil-based dressing you have to eat it. Ask for the chef to leave (such as Italian, French or vinaigrette) served off the sauces and gravies. Order the smaller- on the side (dip your fork into the dressing sized portion if available. and then spear the salad). Avoid salads made with cream cheese, mayonnaise, sour cream, Eating healthfully at fast-food restaurants bacon, high-fat meats or eggs. Most restaurant can be a challenge. Choose a small hamburger soups are salty. Avoid cream soups and or grilled chicken sandwich instead of a chowders, as these soups are high in fat and double or triple cheeseburger. Some fast-food salt. Some vegetable and chicken-based soups restaurants offer side salads and low-fat or can be low in fat. fat-free salad dressings. Avoid fatty sandwich toppings, such as bacon, mayonnaise and Entrees cheese—choose lettuce, tomato, onion, ketchup and mustard instead. Choose baked or broiled fish (without fat added), grilled or roasted chicken or turkey Avoid “supersizing,” which can add significant (do not eat the skin), lean veal, pork or beef amounts of fat and calories to your meal. (limit the amount to 3 ounces). If the portion For example, an extra-large soft drink (48 served is large, you can share it with someone ounces) adds about 450 calories, and an or take some home for another meal. extra-large order of French fries (7 ounces) adds about 600 calories to your meal. Starches Many fast-food restaurants have nutrition Select a baked potato (avoid sour cream and information on their Web sites or information butter), unbuttered rice, noodles or other pasta, may be available at the restaurant. Frequently plain rolls or bread. Avoid buttered noodles and eating at fast-food restaurants is not rice, rice pilafs or wild rice dishes, au gratin, recommended, but when you do, use the scalloped, fried, buttered or mashed potatoes. available nutrition information to help you make better food choices. Vegetables Ask for vegetables made without fat. Avoid vegetables that are buttered, creamed or made with fat or cheese.
57 Eating with Your Heart’s Consent
Desserts Nutrition Facts Choose fruit ice, low-fat ice cream, frozen The Nutrition Facts section of the label will help yogurt, sherbet or angel food cake. Avoid you decide which foods are good choices. Start pies, cakes, cookies, ice cream, puddings by reading the serving size. and custard. Serving Size—Is it a normal serving for you? Beverages If you normally eat half or twice that serving Select skim or 1% milk if available (or the size, then you will get half or twice the amount lowest fat milk available), coffee, unsweetened of nutrients per serving. tea, juices (made with 100% juice) or diet soft drinks. Alcoholic beverages and drinks made Total Fat—The number next to Total Fat is the with caffeine are allowed if approved by your number of grams of fat in a serving size. If you doctor. Avoid whole milk and drinks made normally eat twice the serving size listed, you with ice cream. will eat double the grams of fat listed.
Shopping and Cooking Tips Saturated Fat—Next look at the numbers for saturated fat. The lower the number, the better. Read Food Labels Make a habit of reading labels before buying food. Use them to compare different foods and different brands. Try to find the foods with the lowest amount of fat, cholesterol and sodium.
Ingredient Listings Food labels tell you what ingredients are in the product. They are listed in decreasing order of how much is in the food. Avoid foods made with ingredients high in cholesterol, saturated fat or sodium. In general, look for foods with no more than 3 grams of fat per 100 calories or no more than 30 percent of the total calories coming from fat.
Facts from a whole grain cereal
58 Eating with Your Heart’s Consent
Trans Fat—The lower the number, the better. If this number is not listed separately on the label, add up the grams of saturated fat, monounsaturated fat and polyunsaturated fat. The difference between this number and the Total Fat listed can tell you how much trans fat is in one portion of that food.
Foods with 3 grams of fat or less per serving and 1 gram or less of saturated fat usually can be worked into your diet. Foods with more total fat or saturated fat also can be part of your diet, but you need to be careful about how much and how often you eat these foods. Remember that you do not want more than one-third of your total fat intake for the day to come from saturated fat.
Cholesterol—Look at the numbers for cholesterol. You should eat no more than 200 milligrams per day. Remember that only animal products contain cholesterol. Meats, fish, some dairy products and cheese will have high numbers. Fruits, vegetables and grain products will not have any unless animal products are added. “Fat-Free” Foods
Sodium—Look at how much sodium is in • Check serving sizes. Some of these foods are made a serving. Your goal is to eat no more than with fat. The amount of fat in the serving size listed 1,500 milligrams per day. may be so small that the product can be labeled fat free. You may be getting some fat if you eat % Daily Value—This column is just a general larger portions of these foods. guide. It is based on a person who eats 2,000 • Check the calories and sodium in a serving. calories per day. It shows what percentage Many of these foods are high in sugar, calories of the daily recommended amount of nutrients or sodium. You may need to limit your servings you would get in one serving of the food. or limit the sugar and sodium in your diet if you Since you may eat more or less than 2,000 are trying to lose weight. calories per day, these numbers may not be correct for you.
Many foods are labeled as “low-fat,” “lean,” “low saturated fat,” “light” and so on. Some of these foods may be good choices, while others may not. Be sure to read the nutrition information on the label.
59 Eating with Your Heart’s Consent
Manufacturers’ Terms Light—the product contains one-third fewer calories or half the fat of the “regular” product. Here are definitions of terms commonly If the food gets one-half or more of its calories used by manufacturers: from fat, there must be a reduction of 50 percent of total fat or calories (the term “light” Sodium Free—less than 5 mg of sodium also can mean color or texture). per serving Lean—less than 10 grams of fat, with less than Salt Free—meets the requirements 4 grams of saturated fat, and less than 95 mg for “Sodium Free” (see above) of cholesterol per 3-1/2 ounce serving (or 100 gram serving) Very Low Sodium—35 mg or less sodium per serving Extra Lean—less than 5 grams of fat, with less than 2 grams saturated fat, and less than 95 mg Low Sodium—140 mg or less sodium cholesterol per 3-1/2 ounce serving (or 100 per serving gram serving)
Reduced Sodium—at least 25 percent Follow these guidelines when less sodium when compared with the “regular” product selecting convenience foods: Frozen Meals—meals should contain less Less Sodium—at least 25 percent less sodium than 600 mg of sodium and less than 10 grams when compared with the “regular” product of fat, or a single entree with less than 250 mg of sodium and less than 3 grams of fat Light in Sodium—50 percent less sodium per serving when compared with the Sweets—one serving should contain less than “regular” product 140 mg of sodium and 3 grams of fat or less
Unsalted, Without Added Salt, No Salt Added— Snack Foods—one serving should contain less no salt is added during processing than 140 mg of sodium and 3 grams of fat or less
Fat Free—contains a trivial amount of fat, Cheese—one serving should contain less saturated fat or cholesterol than 250 mg of sodium and 5 grams of fat or less per ounce Low Fat—3 grams of fat or less per serving
Low Saturated Fat—1 gram of saturated fat or less per serving
Low Cholesterol—20 mg of cholesterol or less per serving
60 Eating with Your Heart’s Consent
Buying Meat, Fish, Poultry Fat-Free Broth or Juice • Choose only very lean cuts of meat. There • Use fat-free juice from meat for au jus. It also are different grades of meat, partly based on can be used as a soup base or thickened for gravy. the amount of fat. “Prime” meat has the most fat. “Choice” meat has less fat. “Select” meat Use one of these methods to make fat-free is even lower in fat. meat broth: • Trim all visible fat from meat. Do not eat • Add ice cubes to cool quickly. Remove fat as it poultry skin. becomes solid. • Plan correct portion sizes. Meat will shrink a little • Refrigerate for a number of hours. Remove solid fat. during cooking. A piece of cooked meat the size • Skim fat off the top with a paper towel or sponge. of a deck of cards is about 3 ounces. • Use a special measuring cup with a bottom spout. • Braise, broil, roast, grill or poach your meat, The fat-free broth will pour out first. fish and poultry. • Do not fry. Instead, dip meat in skim milk, plain Chocolate yogurt, egg substitute or egg white, then dip • Regular chocolate contains saturated fat. Cocoa into bread crumbs and bake. powder can be used instead, since most of the fat has been removed. Using Butter, Margarine and Oils • Is margarine or butter better? Butter contains If a recipe calls for 1 ounce unsweetened cholesterol, and some margarines contain trans baking chocolate, substitute 3 tablespoons fats. Select a soft tub margarine free of cholesterol cocoa powder plus 1 tablespoon allowed oil. and trans fats with no more than 2 grams of saturated fat per serving. Cream Cheese • Use only recommended oils and margarines • Use fat-free cream cheese in place of regular when cooking. Use the smallest amount you can. cream cheese. • Soft tub margarines work well as bread spreads • A low-fat, low-cholesterol substitute can be and on vegetables and potatoes, but may not made with plain yogurt: Pour low-fat or nonfat work well in baked goods. Use stick margarine plain yogurt into a colander or strainer lined with or recommended oils instead when baking, but a coffee filter or cheesecloth. Place a container use the smallest amount you can. underneath strainer, and cover with a clean dish towel. Allow to drain in refrigerator for 24 hours. Substitute Monounsaturated and Polyunsaturated Fats for Saturated Fats Cream Soup Base If a recipe calls for 1 cup margarine or butter, • Mix chunks of cooked potato, skim milk substitute 3/4 cup unsaturated oil. and onion in a blender. If a recipe calls for 1 cup solid shortening, substitute 2/3 cup unsaturated oil. If a recipe calls for 1 tablespoon margarine, substitute 2-1/4 teaspoons unsaturated oil.
61 Eating with Your Heart’s Consent
Eggs Sour Cream Substitute egg whites or egg substitutes • Use fat-free or low-fat sour cream. Plain, for whole eggs: unflavored, fat-free or low-fat yogurt also • If a recipe calls for 1 whole egg, substitute with can be used. 2 egg whites or 1/4 cup egg substitute, or 1 egg white plus 1 teaspoon oil Tomato Sauce • If a recipe calls for 1 egg yolk, substitute with • Buy low-fat, low-sodium tomato sauces. 1 tablespoon cornstarch, flour or arrowroot • Make your own sauce. Start with “no salt added” per 1/2 cup of liquid. canned tomatoes, tomato paste or tomato juice. Add lots of onions, herbs and spices. “No salt Seasoning added” canned crushed tomatoes only need • Avoid using added fat or salt for flavor. Instead, to be heated with some basil, garlic and use herbs and spices—onions, garlic (or onion oregano for a quick, tasty sauce. and garlic powders), black or cayenne pepper, basil, sage, thyme, rosemary, cinnamon, nutmeg, White Sauce Base oregano or tarragon. • Melt 1 to 2 tablespoons of allowed oil or margarine. • Try fruits and fruit juices to flavor meats and Add 1 to 2 tablespoons of flour. Cook for a few vegetables. Pineapple, apple, apricot, lemon minutes over low heat, stirring often. Slowly add and orange work well with many foods. 1 cup skim milk. Continue to stir over low heat until • Low-fat sauces like salsas also can make sauce thickens. foods more tasty.
62 Eating with Your Heart’s Consent
Heart-Healthy Recipes
Here are some low-fat, low-salt recipes to get you started.
Meat Dishes Makes 4 servings. Nutrition facts per serving: Oven-Fried Parmesan Chicken 280 calories 4 boneless, skinless chicken breast halves 34 grams protein 1 cup nonfat plain yogurt 16 grams carbohydrates 3/4 cup plain bread crumbs 4 grams fat 4 tablespoons Parmesan cheese 1 gram fiber 2 tablespoons flour 74 mg cholesterol 1 tablespoon paprika 80 mg calcium pinch cayenne pepper 2 grams iron 1 teaspoon onion powder 316 mg sodium 1/2 teaspoon garlic powder Nonstick cooking spray
1. Place the chicken in yogurt and refrigerate. Preheat oven to 450° F. 2. Mix the remaining ingredients (except cooking spray) in a Ziploc bag. Place the chicken in the bag and shake one piece at a time. 3. Place chicken on prepared baking sheet and lightly spray the top with nonstick spray. Bake 20 minutes or until chicken is fork-tender and juices run clear.
Recipe Source: Nutrition Council of Greater Cincinnati www.nutritioncouncil.org
63 Eating with Your Heart’s Consent
Lemon-Herb Roast Chicken 1. Preheat the oven to 350° F. Lightly spray a Vegetable oil spray roasting pan and rack with vegetable oil spray. 1/2 tablespoon dried thyme, crumbled 2. In a small bowl, stir together the thyme, basil, 1/2 teaspoon dried basil, crumbled pepper and salt. 1/2 teaspoon pepper 3. Discard the giblets and all the visible fat from 1/4 teaspoon salt the chicken. Rub the outside of the chicken 4-pound roasting chicken with the herb mixture. Put the chicken with 2 medium garlic cloves, minced the breast side up on the rack in the roasting 1 lemon, cut into wedges pan. Put the garlic, lemon, bay leaf and onion 1 bay leaf in the chicken. Pour the wine into the pan. 1/2 medium onion 4. Lightly spray the outside of the chicken with 1/2 cup dry white wine (regular or nonalcoholic) vegetable oil spray. 5. Bake for 20 minutes per pound, or until the internal temperature reaches 180° F or the juices run clear when a thigh is pierced with a sharp knife. 6. Let rest for 15 minutes before carving. Discard the skin before serving the chicken.
Makes 6 servings. Nutrition facts per serving: 188 calories 31 grams protein 1 gram carbohydrates 0 grams fiber 102 mg cholesterol 4.5 grams total fat 1 gram saturated fat 1 gram polyunsaturated fat 1.5 grams monounsaturated fat 210 mg sodium
This recipe is reprinted with permission from “The New American Heart Association Cookbook,” Seventh Edition, Copyright ©2004 by the American Heart Association. Published by Clarkson Potter/Publishers, a division of Random House, Inc. Available from booksellers everywhere.
64 Eating with Your Heart’s Consent
Chicken and Vegetable Soup 1 pound boneless, skinless chicken breasts, all visible fat discarded 1 medium zucchini, thinly sliced 1 medium red bell pepper, chopped 1-3/4 cups fat-free, low-sodium chicken broth 2 ounces dried no-yolk egg noodles 1/2 cup frozen whole-kernel corn 1/2 cup water 1/2 teaspoon dried thyme, crumbled 4 or 5 medium green onions (green and white parts), finely chopped (about 1/2 cup) 1/4 cup finely snipped fresh parsley 1 tablespoon olive oil 1/2 teaspoon salt 1/4 teaspoon pepper 2 tablespoons shredded or grated Parmesan cheese
1. Cut the chicken into bite-size pieces. 2. Heat a Dutch oven over medium-high heat. Remove from the heat and lightly spray with Makes 4 servings. vegetable oil spray (being careful not to spray Nutrition facts per serving: near a gas flame). Cook the chicken for 2 to 3 268 calories minutes, or until no longer pink on the outside, 31 grams protein stirring constantly. Transfer the chicken to a plate. 21 grams carbohydrates 3. Lightly spray the Dutch oven with vegetable oil 4 grams fiber spray (no need to wipe clean first). Cook the 68 mg cholesterol zucchini and bell pepper for 2 minutes, or until 6 grams total fat just beginning to brown lightly on the edges, 1.5 grams saturated fat stirring constantly. 1 gram polyunsaturated fat 4. Stir in the broth, noodles, corn, water, and 3 grams monounsaturated fat thyme. Increase the heat to high and bring 436 mg sodium to a boil. Reduce the heat and simmer, covered, for 10 minutes. 5. Stir in the chicken and any accumulated juices. Cook for 3 minutes, or until the chicken is no longer pink in the center. Remove from the heat. This recipe is reprinted with permission 6. Stir in the remaining ingredients except from “The New American Heart Association Cookbook,” Seventh Edition, Copyright the Parmesan. ©2004 by the American Heart Association. 7. To serve, ladle into bowls. Sprinkle with Published by Clarkson Potter/Publishers, the Parmesan. a division of Random House, Inc. Available from booksellers everywhere.
65 Eating with Your Heart’s Consent
Fish Dish Vegetarian Dishes
Baked Herbed Fish with Rice Glazed Sweet Potatoes 6 cups cooked rice 2 medium sweet potatoes 1-1/2 lbs. catfish, cod, orange roughy, 1/2 cup unsweetened apple juice or cider haddock or other filleted fish 1 teaspoon oil 1. Wash and cut potatoes into chunks. pinch of salt 2. Place in small saucepan, cover with water 1 teaspoon thyme or tarragon and bring to a boil. 1 teaspoon minced garlic 3. Boil for 10 to 15 minutes or until tender. 3/4 cup fresh or frozen chopped onion Drain and let cool slightly. 1 cup white wine or skim milk (not both) 4. When cool enough to touch, slip off skin. sprinkle of paprika Add apple juice and cook over low heat until the liquid forms a shiny glaze. 1. Start cooking rice. Preheat oven to 400° F. 2. Place fish fillets in baking dish. Combine Makes 3 servings. oil with thyme, salt and garlic. Spread over Nutrition facts per serving: fish. Top with onions. Pour wine or milk 188 calories over the fish. 2 grams protein 3. Bake for 10 to 15 minutes or until fish flakes 44 grams carbohydrates with a fork. 2.7 grams fiber 0 grams fat Makes 4 servings. 0 mg cholesterol Nutrition facts per serving: 25,000 IU vitamin A (498% RDA) (includes 1-1/2 cups rice per serving): 25 mg vitamin C (42% RDA) 528 calories 36 mg calcium 47 grams protein 1.6 mg iron 73 grams carbohydrates 22 mg sodium 2 grams fiber 2 grams fat Recipe Source: Nutrition Council of Greater Cincinnati 93 mg cholesterol www.nutritioncouncil.org 147 mg calcium 433 mg iron 211 mg sodium
Recipe Source: Nutrition Council of Greater Cincinnati www.nutritioncouncil.org
66 Eating with Your Heart’s Consent
Mashed Sweet Potatoes for One Baked Fries with Creole Seasoning 1 medium sweet potato 4 medium unpeeled russet potatoes 1 to 2 tablespoons orange or pineapple juice (1-1/4 to 1-1/2 pounds) 1/8 to 1/4 teaspoon cinnamon, nutmeg Creole or Cajun Seasoning: or ginger 1/2 teaspoon chili powder 1/2 teaspoon ground cumin 1. Wash sweet potato and pierce it several times 1/2 teaspoon onion powder with a fork, then place on a paper towel. 1/2 teaspoon garlic powder 2. Microwave for approximately 6 minutes or until 1/2 teaspoon paprika cooked through. Let sit for 1 to 2 minutes. 1/2 teaspoon black pepper 3. Cut open and mash with juice and seasonings 1/4 teaspoon salt to taste. 1/8 teaspoon cayenne (optional) Vegetable oil spray Makes one serving. Nutrition facts per serving: 1. Cut the potatoes into long strips about 1/2” 120 calories wide. In a large bowl, soak for 15 minutes 2 grams protein in enough cold water to cover by 1.” 29 grams carbohydrates 2. Meanwhile, in a small bowl, stir together the 2.7 grams fiber seasoning ingredients. Set aside. Preheat the 0 grams fat oven to 450° F. Lightly spray a large baking 0 grams cholesterol sheet with vegetable oil spray. 25,000 IU vitamin A (498% RDA) 3. Drain the potatoes and pat dry with paper towels. 25 mg vitamin C (42% RDA) Spread the potatoes in a single layer on the baking 29 mg calcium sheet. Lightly spray the tops with vegetable oil 1.6 mg iron spray. Sprinkle with the seasoning mixture. 21 mg sodium 4. Bake for 30 to 35 minutes or until crisp.
Recipe Source: Nutrition Council of Greater Cincinnati Makes 4 servings. www.nutritioncouncil.org Nutrition facts per serving: 106 calories 4 grams protein 27 grams carbohydrates 3 grams fiber 0 mg cholesterol 0 grams total fat 150 mg sodium
This recipe is reprinted with permission from “The New American Heart Association Cookbook,” Seventh Edition, Copyright ©2004 by the American Heart Association. Published by Clarkson Potter/Publishers, a division of Random House, Inc. Available from booksellers everywhere.
67 Eating with Your Heart’s Consent
Basic Stir-Fried Vegetables Makes 4 servings. 1 tablespoon oil Nutrition facts per serving 1 teaspoon ground ginger (includes 1 cup steamed rice): 1 teaspoon minced garlic 250 calories 1 lb. vegetables (see suggested combinations) 4 grams fat 1 teaspoon cornstarch 2 tablespoons water Recipe Source: Nutrition Council of Greater Cincinnati 1/4 cup to 1/2 cup chicken or vegetable broth www.nutritioncouncil.org. 1 tablespoon reduced-sodium soy sauce 1/2 teaspoon sugar
1. Clean and chop or slice vegetables for cooking Suggested Combinations for or use pre-cleaned and chopped varieties. Basic Stir-Fried Vegetables 2. Combine broth, soy sauce, ginger and sugar • Cabbage, onions, green pepper, fresh in a small bowl. Combine water and cornstarch mushrooms, carrots and snow peas in a separate small bowl. 3. In a large skillet sprayed with nonstick spray, • Chinese cabbage and dried mushrooms heat oil. Add garlic and stir-fry for about 30 • Broccoli, fresh mushrooms and carrots seconds. Add vegetables according to their • Zucchini, green pepper, mushrooms, cooking times. Stir-fry until crisp tender. onions and tomatoes 4. Add broth mixture. Simmer, covered, until vegetables are done. Thicken sauce with • Cauliflower and fresh mushrooms cornstarch paste. Serve with steamed rice.
68 Eating with Your Heart’s Consent
Desserts Simply Superb Banana Cream Pie 2 cups sliced banana (2 medium bananas) Chocolate Oatmeal Cookies 1 chocolate-flavored graham cracker pie crust 1-1/2 cups firmly packed light brown sugar 1 package sugar-free instant banana 1/2 cup sifted unsweetened cocoa powder pudding mix 1/2 cup fat-free milk 2/3 cup nonfat dry milk powder 1/4 cup acceptable stick margarine, softened 1-1/3 cups water 1/4 cup pureed dried plums or unsweetened 1 cup light whipped cream baby food dried plums 1 tablespoon chocolate syrup 2 teaspoons vanilla extract 1-3/4 cups all-purpose flour 1. Layer bananas on bottom of pie crust. In a 2-1/2 teaspoons baking powder medium bowl, combine dry pudding mix and 1/4 teaspoon salt dry milk powder. Add water. Mix well using a 1-1/2 cups uncooked quick-cooking oatmeal wire whisk. Blend in 1/4 cup light whipped cream. Pour mixture over bananas. Refrigerate for about 1. Preheat the oven to 350° F. 15 minutes. 2. In a large mixing bowl, cream the brown sugar, 2. Spread remaining 3/4 cup light whipped cream cocoa powder, milk, margarine, dried plums evenly over filling. Drizzle chocolate syrup over and vanilla. top. Refrigerate until ready to serve. 3. In a small bowl, sift together the flour, baking powder and salt. Beat into the brown sugar mixture. Makes 8 servings. 4. Stir in the oatmeal. Nutrition facts per serving: 5. Drop by teaspoonfuls onto ungreased baking 214 calories sheets. (You should have about 60 cookies.) 6 grams fat 6. Bake for 7 to 9 minutes, or until set in the center 38 grams carbohydrates (the cookies don’t jiggle when gently shaken). 3 grams protein 1 mg cholesterol Makes 30 servings. Two cookies per serving. .7 grams fiber Nutrition facts per serving: 78 mg calcium 100 calories .7 mg iron 2 grams protein 298 mg sodium 21 grams carbohydrates 1 gram fiber Recipe Source: Adapted by the Nutrition Council 0 mg cholesterol of Greater Cincinnati from “Healthy Exchanges Cookbook” 1 gram total fat by JoAnna M. Lund. 77 mg sodium www.nutritioncouncil.org
This recipe is reprinted with permission from “The New American Heart Association Cookbook,” Seventh Edition, Copyright ©2004 by the American Heart Association. Published by Clarkson Potter/Publishers, a division of Random House, Inc. Available from booksellers everywhere.
69 Eating with Your Heart’s Consent
1-2-3 Peach Cobbler 1/2 teaspoon ground cinnamon 1 tablespoon tub margarine 1 tablespoon vanilla extract 1 cup dry pancake mix 2 tablespoons cornstarch 2/3 cup all-purpose flour 1 cup peach nectar 1/4 cup sugar 2/3 cup pineapple juice or peach juice 2 cans (16 oz. each) peaches, packed in juice, drained; or 1-3/4 lb. fresh, sliced peaches 2/3 cup evaporated skim milk 1/4 teaspoon nutmeg 1 tablespoon brown sugar
1. Combine cinnamon, vanilla, cornstarch, peach nectar and pineapple or peach juice in sauce pan over medium heat. Stir constantly until mixture thickens and bubbles. Add sliced peaches to mixture. Reduce heat and simmer for five to 10 minutes. 2. In another sauce pan, melt margarine and set aside. Lightly spray 8” square glass dish with cooking spray. Pour hot peach mixture into dish. 3. In another bowl, combine pancake mix, flour, sugar and melted margarine. Stir in milk. Quickly spoon this over peach mixture. Combine nutmeg and brown sugar. Sprinkle on top of batter. Bake at 400° F for 15 to 20 minutes or until golden brown. Cool and cut into 8 pieces.
Makes 8 servings. Nutrition facts per serving: 271 calories 4 grams total fat less than 1 mg cholesterol 263 mg sodium 2 grams total fiber 4 grams protein 54 grams carbohydrates
Recipe source: Nutrition Council of Greater Cincinnati www.nutritioncouncil.org
70 Exercising for a Healthier Heart
Exercising frequently is one of the best things Make Exercise a Permanent Part you can do for your heart. Cardiovascular fitness of Your Life allows the heart and blood vessels to supply the body with the oxygen it needs during rest and It is important to design a lifelong home exercise routine. Walking is one of the easiest exercise. A fit person will be able to carry out and most convenient options, but there may daily activities with little or no fatigue. You also be others you enjoy. Cardiovascular exercise will be able to respond to physical and emotional should be continuous and rhythmical. It should stress without an excessive increase in heart rate be done at a comfortable pace. The “no pain, and blood pressure. Check with your doctor no gain” principle does not apply. If you stick before beginning any exercise program to see with a regular, consistent program, you can if you have any exercise restrictions. expect these rewards: • More energy and endurance (stamina) throughout the day • Improved appearance —a slimmer, trimmer body —better blood flow throughout your body —better posture • Decreased weight —less body fat —increased muscle tone • Decreased appetite following exercise • Increased efficiency of the heart —lower heart rate and blood pressure —more blood pumped out of the heart with each beat • Stronger heart muscle: the more you use your heart muscle, the stronger it becomes • Improved use of oxygen in the body. The ability of the body to use oxygen effectively is considered by many to be the best measure of overall fitness • Better sleep at night • Stronger bones and a lower risk of osteoporosis • Better resistance to disease • Decrease in LDL and increase in HDL • Lower stress, anxiety, boredom, frustration and simple depression
71 Exercising for a Healthier Heart
How to Design an Exercise Program There are two ways to tell if you are working out safely: Your exercise plan should be based on the Talk Test: You should be able to talk normally FITT principle: while exercising. If you are too short of breath Frequency of training to carry on a conversation, you are working too Intensity of training hard. Slow down. Time of training Type of training Target Heart Rate: You should keep your target heart rate within the range given to you by your Get approval from your doctor before starting doctor or cardiac rehab staff. Generally, 75 your program. percent of maximum heart rate is considered adequate. The formula for calculating your Frequency maximum heart rate = 212 – your age. According to national guidelines, adults need to get two hours, thirty minutes (150 minutes) of moderate physical activity per week (thirty minutes, five times a week). Diabetics need to exercise seven days a week to help control blood sugar levels. People who only exercise “every once in a while” have a greater risk of exercise-related heart attack compared to those who work out more regularly, according to a report from the American Heart Association.
Intensity You will get the most benefit for your heart when you exercise hard enough to get your heart rate (pulse) 20 points above resting.
Exercise should be at a comfortable yet moderate level.
Your doctor may recommend a specific number (pulse rate) for how fast your heart should beat for safe exercise. This is called your target heart rate. Slow down if you get above this heart rate. If you are not in cardiac rehab, ask your doctor about your target heart rate. Exercising above your target heart rate increases the risk of problems and is not advised for people with heart disease.
72 Exercising for a Healthier Heart
How to Take Your Pulse Number of beats per 10 seconds (x 6) Your pulse or heart rate is the number = Pulse Rate of times your heart beats in one minute. 8 = 48 18 = 108 Checking your pulse will help you and your 9 = 54 19 = 114 doctor know how your heart is handling the exercise. Your nurse can help you find your 10 = 60 20 = 120 pulse. It is found at the wrist below the base of the thumb. 11 = 66 21 = 126
You also can take your pulse on your neck 12 = 72 22 = 132 between your voice box and the big muscle on the side of your neck. 13 = 78 23 = 138
Use the pads of your first two to three fingers, 14 = 84 24 = 144 not your thumb. Press gently until you can count the beats and feel the rhythm of the 15 = 90 25 = 150 pulse. Using a watch or clock with a second 16 = 96 26 = 156 hand, count how many beats you feel in 10 seconds. Multiply the number you get by 17 = 102 27 = 162 six to get the number of beats in one minute, which is your pulse rate. If your pulse feels slow, fast or jumps around, count the beats for one full minute (60 seconds).
Practice counting your pulse. Practice is necessary to assure accuracy, especially with exercise.
73 Exercising for a Healthier Heart
Time How to Exercise If you are just starting an exercise program, begin with five to 10 minutes of exercise, four Each exercise session should start with a warm- times a day. Add five minutes more each week up and stretching, and end with a cool-down until you are able to do 30 to 60 minutes once and stretching. Wear comfortably fitting shoes a day, most days, every week. with good support. The shoes should not rub or chafe against your feet. Type Warm-up: The best kind of exercise is aerobic. This exercise is done by using your arms and/or A warm-up helps the body prepare for legs in a continuous, rhythmic movement aerobic exercise by slowly raising the body’s in order to increase your heart rate (pulse). temperature and pulse. This is best done by walking or bicycling slowly for five to ten Aerobic activities include: minutes. Warm up may include stretching to improve your flexibility and prevent injuries. Aerobics To stretch properly, stretch the muscle and Running hold that position for 10 to 30 seconds (don’t Dancing bounce). Breathe normally during the stretch Skating (ice or roller) and do not hold your breath. Bicycling/Stationary bike Hiking Aerobic Exercise: Swimming Jogging/Walking Aerobic exercise can make all the muscles in Rowing your body stronger, including your heart. See types of aerobic exercise in the previous column. Pick an aerobic exercise that you enjoy, and you will most likely keep doing it on a regular Cool-Down: basis. Other activities (sports, gardening, The reason for a cool-down is to help the body shopping, housework, etc.) help improve return to a resting state. End your exercise your overall fitness, but will not improve session by slowing down your exercise for five your heart health for long-term benefits. minutes. Then repeat the stretching exercises that you did during your warm-up. This takes Tracking Your Progress away the waste products that build up during One of the easiest ways to monitor your exercise and helps reduce muscle soreness. progress is to write down what you do. The cool down time slowly lowers you heart Keep track of: rate and blood pressure, helps prevent injuries a) weight (record once a week) and reduces the pooling of blood in your legs. b) blood pressure (if you have a home-monitoring kit) Some experts believe this is the most important c) minutes of exercise each day part of your workout. d) symptoms (Are you having any symptoms that would be of concern? If so, be sure to contact your doctor.) e) glucose values (for people with diabetes)
74 Exercising for a Healthier Heart
Stop exercising and tell your doctor if you have Walking any of these symptoms during, or even several hours after, exercise: When you first come home from the hospital, • lightheadedness you should begin to walk daily. If you are feeling • chest discomfort extremely tired and ill on a given day, you can • rapid heart beat skip that day. Walk at a comfortable, easy pace. • jaw discomfort • arm discomfort Follow these guidelines: • upper back discomfort • Do not walk within one hour after meals. • dizziness • Walk on level ground, avoiding hills and grades. • nausea • Walk inside if the temperatures are too hot • unusual shortness of breath or too cold, or during extreme humidity • sudden weakness or a pollution alert. • severe or unusual fatigue • In summer, walk in the cooler part of the • severe discomfort of any kind day and wear light, loose-fitting clothes. • In winter, put on hat and gloves and wear Hints for a Successful a scarf to cover your nose and mouth. • Always carry an ID with you and don’t walk Exercise Program in secluded places. 1. Set short- and long-term goals for yourself. • Carry your cell phone for emergencies. Reward yourself when you meet them. 2. Frequently review how exercise benefits you. Listen to your body. If you develop any form 3. Exercise with music or in front of the television. of chest discomfort, extreme shortness of 4. Wait one hour after eating before exercising. breath, dizziness, sudden weakness or excessive 5. Pick an exercise you like that fits into your lifestyle. sweating, stop and rest five minutes or until 6. Exercise with a friend for both safety and the symptoms go away. Call your doctor if the motivation. symptoms do not go away completely, or if you 7. Follow the walking guidelines to the right. have these symptoms again.
As your body grows stronger after you leave the hospital, you should increase to a moderate, steady walking pace. Follow your doctor’s orders or the instructions given to you.
75 Exercising for a Healthier Heart
Notes:
76 Living with Heart Failure
What is Heart Failure? Past heart attack (myocardial infarction) A part of the heart muscle dies and the Heart failure is not a disease, but a condition remaining healthy muscle has to pump that occurs when your heart does not pump even harder to keep up. as well as it should. This does not mean that your heart has stopped working. Chronic heart High blood pressure (hypertension) failure, a type of heart failure that cannot be When pressure in the blood vessels is too fixed, is a problem that you will have for the high, the heart has to pump harder than rest of your life. Although there is no cure normal. Over time, the heart chambers for chronic heart failure, it can be managed get larger and weaker. successfully.
Abnormal heart valves Causes of Heart Failure When valves don’t open or close completely All of us lose some blood-pumping ability during each heartbeat, the heart muscle has in our hearts as we get older. If you have to work harder to keep the blood moving in heart failure, however, other health problems the proper direction. have either damaged the heart or made it work too hard. If you have heart failure, chances are Heart muscle disease (cardiomyopathy) you have (or had) one or more of the following: or inflammation (myocarditis) Heart muscle can be damaged by drug or Coronary artery disease alcohol abuse, viral infections or unknown Less blood reaches the heart muscle. The area reasons. With any heart muscle damage, of muscle with decreased blood doesn’t pump the rest of the heart has to work harder. as well. The healthy heart muscle that remains has to work harder. Heart defects present at birth If the heart doesn’t form correctly, the healthy parts have to work harder to make up for it.
Severe lung disease When the lungs don’t work properly, the heart has to work harder to get oxygen-rich blood to the rest of the body.
Diabetes Coronary Artery Disease If you have diabetes, you have up to eight times greater risk of having heart failure. The disease process in diabetes can damage the heart muscle. Good control of your glucose (sugar) level can decrease this risk.
Abnormal heart rhythms, too slow or too fast, can make heart failure worse.
77 Living with Heart Failure
Signs and Symptoms Types of Heart Failure
Your heart pumps blood to all parts of your Heart failure can involve the heart’s left side, body—your feet, legs, hands, brain and right side or both. It usually affects the left muscles. Heart failure occurs when the heart side first, causing shortness of breath. The cannot pump enough blood to keep up with term congestive heart failure often is used the body’s needs. Congestion (buildup of fluid) to describe everyone with heart failure. can occur. Because of this, you may notice However, congestion (the buildup of fluid) any of the following signs or symptoms: is just one feature of the condition and • Swelling in the feet, ankles and/or legs does not apply to everyone. • Bloating (fluid in abdomen) • Fluid in your lungs Systolic heart failure occurs if the left side • Cough of the heart loses its ability to pump blood • Shortness of breath with activity, or even at rest throughout the body. The normal heart pumps • Difficulty breathing while lying flat more than half of its blood out of the left side • Waking up with shortness of breath with each beat. The amount of blood that is • Tiredness and fatigue with the simplest activities pumped out is called the ejection fraction. • Loss of appetite A normal ejection fraction is greater than • Nausea 50 percent. With systolic heart failure, the • Weight gain over a short period of time ejection fraction falls below 40 percent. The • Inability to concentrate heart begins to receive more blood than it • Rapid heart rate, often irregular can pump out to the body. Over time, the • Dizziness or lightheadedness heart gets bigger and stretches as it works • Decreased urination harder to pump more blood. • The need to urinate more often during the night Diastolic heart failure occurs when the heart wall becomes thick and stiff over time, and the heart has a problem relaxing. Because the muscle has become stiff, the heart cannot properly fill with blood. The ejection fraction is normal. However, the volume of blood received and pumped by the heart is less than normal. People with this type of heart failure also may have shortness of breath, swelling of the feet and other heart failure symptoms.
The New York Heart Association (NYHA) defines classes of heart failure according to how it affects a person’s life. With medication and lifestyle changes, you may be able to improve your class level and your quality of life.
78 Living with Heart Failure
Class How You Feel
I No symptoms and no limitation in ordinary physical activity.
II Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.
Marked limitation of activity due to symptoms, even during less-than-ordinary III activity. Comfortable only at rest.
IV Severe limitations. Symptoms present even at rest.
Frequent Diagnostic Tests A cardiac catheterization will allow your doctor for Heart Failure to check for blockages in the arteries that supply blood to your heart muscle and check Your doctor makes the diagnosis of heart your heart’s pumping ability. failure by evaluating your symptoms and doing a physical examination. Tests that may be Treating Heart Failure performed include: electrocardiogram (EKG), chest X-ray, echocardiogram (echo), exercise Heart failure caused by structural problems, stress test, multi-gated ventriculogram (MUGA such as a heart valve problem, may be cured. scan) or cardiac catheterization (angiogram). These defects can be fixed with surgery.
An EKG may show if you had a heart attack There is no cure for heart failure caused by in the past or if the left ventricle is thick. It damaged heart muscle. However, treatment also shows any abnormal heartbeats. can improve your quality of life and length of survival. This is accomplished through A chest X-ray shows the outline and size of the lifestyle changes (how you live and eat heart. It also shows any congestion in your lungs. every day) and medication.
An echocardiogram (echo) uses sound waves You can lessen the effects of heart failure by from outside the body to examine the heart’s controlling your risk factors for heart disease: size, shape, movement, valves, muscle and • stop smoking or use of other tobacco products pumping ability. The echo will tell the doctor • lose weight if needed your ejection fraction. • avoid alcohol • make dietary changes to reduce the amount An exercise stress test will look at your heart of salt and fat you eat rhythm while you are exercising. This test may • get regular exercise, but have a doctor monitor show changes in your heart’s electrical pattern the amount and intensity of activity when you are doing aerobic activity.
The MUGA scan will tell how much blood your heart pumps with each beat. This will let your doctor know the strength of your heart muscle.
79 Living with Heart Failure
Several types of drugs have proven useful Cardiac resynchronization (CRT)/biventricular in the treatment of heart failure: pacemaker (BiV) may be used to treat certain • Diuretics (water pills) help reduce the amount types of heart failure. The doctor puts a special of fluid in the body and are useful for persons pacemaker just under your skin near the with fluid retention and high blood pressure. collarbone. The purpose of CRT is to let both • Digitalis increases the force of the heart’s sides of your heart beat together. You usually contractions (pumping action), helping to cannot feel the CRT electrical impulses. improve circulation. • Angiotensin converting enzyme (ACE) inhibitors Living with Heart Failure or angiotensin receptor blockers (ARBs) improve survival and may slow, or perhaps even prevent, Weigh Yourself Daily the loss of heart pumping action. ACE-inhibitors Please do the following: and ARBs lower the pressure inside the arteries • Weigh yourself first thing in the morning after you and veins. As a result, the heart does not have urinate and before eating. to work as hard to pump the blood through • Weigh yourself without clothes on. the vessels. • Use the same scale and place it on a hard surface. • Beta blockers block the effects of harmful stress • Write down your weight every day on a hormones (substances produced by your body weight record. that make heart failure worse and contribute • Call your doctor if your weight goes up by 2 to 3 to your symptoms). pounds overnight, or if it goes up 5 pounds over • Aldosterone inhibitors prevent the retention a week. of salt and fluid in the body. This may prevent • Bring your weight record with you to every your heart failure from getting worse. doctor’s appointment. • Take your medications as prescribed. Pacemakers and Defibrillators Pacemakers and defibrillators are devices Maintain Daily Activities and Exercise that are placed by the doctor to help your Depending on how bad your heart failure is, heart failure. The doctor puts the device just you may have difficulty with your daily activities. under your skin, near the collarbone. Insulated Always consult your doctor for suggestions on wires are threaded through blood vessels and daily activity and exercise. connected to the device. The wires may be placed in one or both sides of the heart. The benefits of regular exercise include: • Strengthens muscles Internal cardioverter defibrillator (ICD) is a • Helps you feel better emotionally device used to reset the heart if it goes into • Helps you sleep better an erratic or very fast rhythm. This is used • Reduces stress and tension to prevent sudden death. A jolt is felt when • Helps you control hypertension the ICD fires. If this happens, go to the (high blood pressure) emergency room. • Helps you control cholesterol
80 Living with Heart Failure
Suggestions for managing your Eat Healthy daily activities: • Pace yourself throughout activities—don’t rush. You will need to make changes in the food • Space activities throughout the day, allowing you eat and limit the amount of sodium that for lots of rest periods. you eat. The most common source of sodium is table salt. Too much sodium in your diet can Suggestions for exercise: cause your body to hold more fluid. This extra fluid makes it harder for your heart to pump. • Comfortable, easy exercise is recommended for Your doctor will tell you how much sodium most people who have heart failure. Studies show you are allowed. Usually the amount is exercise may slow the progression of heart failure 2,000 mg (2 grams) per day. and decrease your symptoms. 1 level teaspoon of salt = 2,400 mg of sodium • Regular exercise may help you feel better and become stronger so that you can enjoy your regular activities. It can give you a more positive Here are some ways to limit the amount outlook on life. of sodium in your diet. • Avoid outdoor exercise when it is too hot, too 1. Read labels on the food you buy. Choose humid or too cold. reduced-sodium foods. • Stop what you are doing if you have any 2. Limit the use of canned, ready-to-use and of the following: processed foods that are high in sodium such –Increased or unusual fatigue as bacon, sausage, cold cuts, frozen dinners, –Increased shortness of breath canned soups, chips and other salted snacks. –Coughing after exertion 3. Limit or avoid high-sodium condiments such –Lightheadedness or dizziness as soy sauce, pickles, olives, BBQ sauce, mustard –Chest pain and ketchup. 4. Use other seasoning such as pepper, garlic, onions, salt-free herb blends or herbal vinegar. Do not add salt at the table. This includes anything that says “salt” on the label such as garlic salt, seasoned salt or onion salt. See “Eating with Your Heart’s Consent” in this book for low-sodium seasoning ideas.
You may be asked to limit the amount of fluids you drink. The heart’s work is easier if it has less fluid to pump. Discuss with your doctor the amount of fluids that you should drink.
81 Living with Heart Failure
So…What Can You Eat? A 2-gram sodium diet can include a wide variety of foods. Fresh meats, such as lean beef and fresh pork (such as pork chops or pork roast), chicken and fish should be limited to 6 ounces per day. Choose yogurt, graham crackers, fresh fruit and vegetables, unsalted pretzels or dry cereal such as Frosted Mini-Wheats.
Fresh, frozen and canned fruits are very low in sodium, as are fresh and frozen plain vegetables (avoid frozen vegetables in sauces or butter). Choose fresh potatoes or noodles cooked without added salt, instead of convenience mixes. Breads, cereals and baked goods can be included in the diet in moderate amounts. See the 2-gram sodium food list on the following pages for more details.
Choose carefully when eating out, as restaurant meals can be high in sodium. Avoid foods that contain salty ingredients, such as sandwiches with bacon or ham, or entrees that contain cheese or cheese sauce. Avoid soups in restaurants. Ask for salad dressing on the side, so you can control how much you use, or ask for oil and vinegar for your salad. If you’re not sure how a menu item is prepared, ask your server.
Remember, if you have diabetes and/or
high cholesterol or coronary artery disease, you will need to limit fat, cholesterol, and/or carbohydrates in your diet, in addition to limiting salt. Refer to “Eating with Your Heart’s Consent” in this book for help making low-fat, low-cholesterol food choices. Your dietitian also can help you make the right food choices. Taking the time to plan meals can take the guesswork out of eating a diet that has multiple restrictions.
82 Living with Heart Failure
Two-Gram Sodium Food List
Food Group Allow Avoid
Soup Homemade soups made Regular broth or bouillon. Regular without added salt and canned or frozen soups or dry soup with allowed ingredients. mixes. Any soup made with added Unsalted broth or bouillon. salt or salty ingredients. Low-sodium canned soups. Low-sodium cream soups made with allowed amount of milk.
Meats and Fresh beef, veal, pork, lamb, Canned, dried, salted or smoked Meat Substitutes poultry, game, fresh or meats, such as bacon, ham, salt pork, 1 oz. contains frozen unsalted plain fish sausage, hot dogs, brats, chipped approximately (no breading or batter), beef, corned beef, luncheon meats 22 mg sodium. unsalted canned salmon or Kosher meat. Regular canned or canned tuna. Regular salmon, tuna or sardines. Canned, Limit meat and peanut butter limited to dried, smoked or salted fish. Regular other substitutes 1 tablespoon per day. cottage cheese. Regular cheeses. to 6 ounces per day. As desired: low-sodium Low-fat or fat-free cheese cheese, dried beans and (unless also low in sodium). dried peas (prepared Regular frozen dinners. without salty ingredients— see “Avoid” list). Low-sodium peanut butter.
Eggs Limit eggs to 3 per week. Eggs prepared with salt, salted meat 1 egg contains Occasionally an additional or bacon fat. about 65 mg egg may be substituted for sodium. 2 ounces of meat.
Potatoes and Fresh white and sweet Frozen, instant, powdered or Starches potatoes. Brown or white regular canned potatoes. Seasoned 1/2 cup rice, macaroni, noodles, rice, pasta and potato side dishes provides about pasta prepared without (such as convenience macaroni 5 mg sodium. added salt or high-sodium and cheese mixes, etc.) seasonings. Unsalted potato chips.
83 Living with Heart Failure
Two-Gram Sodium Food List (continued)
Food Group Allow Avoid
Vegetables All fresh or frozen Vegetables and vegetable juices 1/2 cup serving vegetables except those canned with salt. Any vegetable of most fresh listed under “Avoid.” prepared in brine such as sauerkraut, or frozen Low-sodium tomato juice. pickles or hominy. Frozen succotash, vegetables Low-sodium vegetable lima beans and peas. contains about juices. Low-sodium or 10 mg sodium. “no salt added” canned Vegetables cooked with salty meat vegetables. “No salt or salted fat. Regular canned tomato Vegetables added” tomato sauce, sauce, paste or puree. naturally higher paste or puree. in sodium contain about 40 mg sodium per 1/2 cup serving.
Breads and White, whole wheat, whole Breads, crackers or rolls with Cereals grain, Italian, sourdough, salted tops. Quick breads made 1 serving of French breads. Yeast rolls. with regular baking powder, baking regular bread Pita bread. Hamburger or soda, salt or self-rising flour. Prepared contains about sandwich buns. Crackers baking mixes. Salted snack foods. 150 mg sodium. with “unsalted tops” or low- sodium crackers. Unsalted Quick-cooking or instant hot cereals. matzo. Unsalted or low- sodium pretzels.
All cereal except those listed under “Avoid.”
84 Living with Heart Failure
Two-Gram Sodium Food List (continued)
Food Group Allow Avoid
Fats Limit: Salted butter, margarine or regular 1 tsp. of salted • regular butter or margarine salad dressings in excess of daily butter or to no more than 5 tsp. per day. allowance. Bacon, salt pork, fat-free margarine • regular salad dressing to no salad dressings (unless also low contains about more than 1 tbsp. per day. in sodium). 45 mg sodium. One tbsp. of cream cheese can 1 tbsp. regular be substituted for 1 tsp. regular salad dressing butter or margarine. provides between 100– As desired: 200 mg sodium. Unsalted margarine, butter, oil, vegetable shortening, low-sodium mayonnaise, unsalted salad dressings made with allowed ingredients, unsalted gravy.
Fruits All fresh, frozen or canned. None. One serving of fruit contains about 2 mg sodium.
Milk Limit to 2 cups per day: Buttermilk. Malted milk. Milk mixes. 1 cup provides Whole, 2%, 1%, skim milk. Dutch processed chocolate. Regular about 120 mg Reconstituted nonfat dry milk. cheeses. Cottage cheese. sodium. Chocolate milk. Evaporated or condensed milk. Cocoa made with milk allowance. Yogurt. Soy milk.
Beverages Coffee, tea (decaffeinated Commercially softened water or regular). Regular non- (purified water is OK). carbonated beverages. Regular Artificially sweetened beverages soft drinks. Sugar-free (diet) containing sodium. Club soda. soft drinks sweetened with Sports or “energy” drinks. NutraSweet or Splenda. Salt-free club soda.
85 Living with Heart Failure
Two-Gram Sodium Food List (continued)
Food Group Allow Avoid
Desserts Limit to one serving a Any regular dessert in excess 1 regular dessert day from the following of daily allowance. contains about list: regular cakes, cookies, 150 to 350 mg gelatin, pie. sodium. As desired: Fruit ice; sherbet; baked dessert prepared without added salt, baking powder or baking soda. Ice cream, pudding, custard should be used as part of milk allowance.
Seasonings Herbs, spices, pepper, Salt, “lite” salt, “Salt Sense,” seasoning sodium-free seasoning salts such as celery salt, garlic salt mixes such as Mrs. Dash. and onion salt. Lemon pepper Fresh garlic and onion. (unless sodium-free). Monosodium Garlic and onion powders. glutamate (MSG). Meat tenderizers. Butter substitutes, such as Cooking wines. Some flavored Molly McButter. vinegars (check label).
86 Living with Heart Failure
Your Heart Failure Management— When to Call Your Doctor It Takes Teamwork Please call your doctor if you have any The daily management of your heart failure of these symptoms commonly associated is like a team working to put a puzzle together. with heart failure. By treating these symptoms The pieces of the puzzle are: fluid balance, early, you can prevent or decrease your time diet, activity and medications. Each player in the hospital. on the team has certain responsibilities to • Have more trouble breathing, especially complete the puzzle, and you are the most if you’re lying down. important part of the team. • Get more tired with simple activities. • Gain more than 2 pounds in a day or 5 pounds You have certain responsibilities: in a week. • Have more swelling than usual in your feet • Weigh yourself daily. and ankles. • Eat healthy. • Have decreased appetite or bloating in • Maintain daily activity and exercise. the abdomen. • Take all medications as prescribed and report • Cough at night or have a cough that won’t any side effects. go away. Your family can help by: • Faint or have dizzy spells. • Have tightness, pressure or pain in your chest. • Watching for swelling, shortness of breath, • Have palpitations—abnormal heartbeats that or changes in how you are feeling. They may are forceful, rapid, slow or irregular. be able to see changes before you do. • Have trouble with your pills. • Supporting you in your efforts to eat the • Urinate less often. right foods. • Encouraging you to stay active. • Knowing the medications you are taking, Resources and reminding you to take them. The following Internet sources have good information about heart failure. Your health care providers also are part of the team. As part of giving you the best possible American Heart Association care, they will give you the information you heart.org need to know. Heart Failure Society of America hfsa.org
National Heart, Lung, and Blood Institute www.nhlbi.nih.gov
87 Living with Heart Failure
Weight Log: Weigh yourself daily at the same time. Record your weight here.
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
W e e k o f ______Weight
88 Living with Heart Failure
Congestive Heart Failure Zones for Management
GREEN ZONE: All Clear RED ZONE: Medical Alert Your Goal Weight: • Unrelieved shortness of breath: shortness • No shortness of breath of breath at rest • No swelling • Unrelieved chest pain • No weight gain • Wheezing or chest tightness at rest • No chest pain • Need to sit in chair to sleep • No decrease in your ability to maintain • Weight gain or loss of more than 5 pounds your activity level in 2 days • Confusion GREEN ZONE MEANS: • Your symptoms are under control Call your physician immediately if you are • Continue taking your medications as ordered going into the RED ZONE • Continue daily weights • Follow low-salt diet RED ZONE MEANS: • Keep all physician appointments • You need to be evaluated by a physician right away YELLOW ZONE: Caution If you have any of the following signs Call your physician right away and symptoms: P h y s i c i a n : ______• Weight gain of 3 or more pounds in 1–7 days • Increased cough P h o n e : ______• Increased swelling I n s t r u c t i o n s : ______• Increase in shortness of breath with activity • Increase in the number of pillows needed ______• Anything else unusual that bothers you ______Call your nurse if you are going into the YELLOW ZONE
YELLOW ZONE MEANS: • Your symptoms may indicate that you need an adjustment of your medications
Call your home health nurse
N a m e : ______
P h o n e : ______
I n s t r u c t i o n s : ______
______
______89 Living with Heart Failure
Notes:
90 Your Diagnosis and Treatment: Coronary Artery Procedures
Treatment for coronary artery disease and Cardiac Catheterization blockages has improved greatly in recent A cardiac catheterization (coronary angiogram) decades, allowing for faster recoveries and is a special test done by a cardiologist to show longer-lasting results. The goal of these if the arteries that feed your heart muscle have procedures is to open blockages and increase any blockages. (See “Understanding Your Heart” blood flow through the coronary arteries to for a description of coronary arteries.) It is the heart muscle. The heart relies on the blood performed by a heart doctor in a special room and oxygen transported by the coronary arteries called a cardiac catheterization laboratory. A to help it work efficiently in pumping blood to soft, hollow tube is threaded up to the heart through an artery in your leg or arm. The all the parts of the body. catheter carries dye that is released in a coronary artery so X-ray pictures can be taken The aim of coronary artery diagnostic and to reveal areas that are clogged or narrowed. treatment procedures is to detect and re-open The doctor can see, on an X-ray screen, the blocked arteries before a heart attack can exact spot where the artery is blocked. cause permanent damage to the heart muscle. The primary diagnostic procedure is a cardiac The doctor also will be able to measure catheterization, also called an angiogram. pressures inside your heart, how well the valves If the angiogram reveals a blockage, various of your heart are working, and how well the treatments, such as balloon angioplasty or stent muscle of your heart contracts (pumps). Heart implants, can be used to enlarge the pathway pumping function is measured and called an through the coronary artery for increased ejection fraction. A normal ejection fraction blood flow. If several blockages are identified, is 50 to 70 percent. coronary artery bypass surgery may be needed to build detours around the blockages.
Aorta
Left Main Artery
Left Circumflex Artery
Left Anterior Descending Artery
Right Coronary Artery
91 Your Diagnosis and Treatment: Coronary Artery Procedures
Before your cardiac catheterization procedure If your coronary arteries are normal, you will you will: not need further treatment. If blockages are • not eat or drink anything after midnight, except found, your doctor may recommend that you for your medications with a small sip of water. have an angioplasty or a stent procedure to • empty your bladder before you leave your room open the blockages. These procedures often or holding area. can be performed at the time of the angiogram. • be asked to sign a consent form that lets us know The doctor also may recommend coronary you understand the procedure and the risks artery bypass surgery and/or medical treatment and benefits. for blockages found. • have blood work drawn and your medical history checked by the staff admitting you. • be given an aspirin if you have not already taken one. • be taken to the procedure room, where two to three staff members will be working for you.
During your procedure you will: • be placed on a heart monitor, have a clip placed on your finger or toe to read the level of oxygen Neck insertion site in your blood and a blood-pressure cuff placed on your arm that will inflate automatically.
• have the hair shaved at the area where the doctor Arm insertion site will be working. This area could be the groin or wrist. The groin is the most common site. • have this area cleaned with a special soap and covered with a sterile sheet. • keep your arms under the sheet and not bend or move your legs. • be given medicine through your IV to help you
relax. You may become very sleepy. Wrist insertion site • be given a local anesthetic (numbing medicine) by the doctor to numb the area where he or she will be putting catheters into the artery. Once the medicine takes effect, you should not feel any pain. Groin insertion site You may feel dull pressure where the doctor is working with the catheters. The doctor will inject dye into the coronary arteries once the catheters Catheter are in place and will be able to see blockages on the X-ray screen. • feel warm all over from the dye. This feeling will only last for 10 seconds. • not feel the catheter because you do not have nerve endings in the coronary arteries.
92 Your Diagnosis and Treatment: Coronary Artery Procedures
After your cardiac catheterization procedure Balloon Angioplasty you will: • be moved to a recovery area. Angioplasty is a procedure using a catheter • be placed on a heart monitor, automatic blood (a hollow tube) with a balloon on it to open pressure cuff and oxygen monitor (a finger clip). a blockage or narrowing of a coronary artery. • be asked to empty your bladder. The procedure also is referred to as percutaneous • have the catheter removed from the artery and transluminal coronary angioplasty (PTCA). have firm pressure applied for 10 to 20 minutes. The procedure takes about 30 to 90 minutes. This is to prevent bleeding. • have your blood pressure and pulses in your feet checked by a nurse every 15 minutes for the first hour. • have a bandage applied to the insertion site. You may have a closure device at the site where the doctor did the procedure if the artery is big enough and the doctor thinks it is appropriate. You will be given written information on this. Narrowing of the artery before balloon angioplasty • have a pressure band on your arm if your wrist was used for the procedure. • need to lay flat for 4 hours after an angiogram, 6 hours after an angioplasty or stent, if insertion site is through the groin. • need to tell the staff right away if you feel a warm, wet feeling at the catheter site; you could be bleeding. Balloon is inflated • need to drink a lot of fluids to help flush the dye out of your body. • need to put your hand over the bandage and press firmly if you need to cough or sneeze. • possibly have a bruise at the site; this is normal. • possibly feel a lump at the site. If the lump is walnut size or bigger, let the nurse know. • have pain medicine available. Artery is opened for better blood flow ©Medtronic • go back to your room. At the time of discharge, you will be given instructions for what to do when you go home: eating, activities, care of the Angioplasty often can be performed while you catheter site, medications, etc. are in the catheterization laboratory for your cardiac catheterization. Your doctor replaces the diagnostic catheter with a guiding catheter, placing a wire through the blockage and following with a balloon catheter. The doctor is able to see the wire and balloon catheter on the X-ray screen.
93 Your Diagnosis and Treatment: Coronary Artery Procedures
The balloon is placed in the center of the The hollow stent, which is mounted on a blockage and inflated to press fatty deposits balloon catheter, is inserted into the coronary (plaque) against the wall of the artery. This artery and placed at the blockage. The balloon opens the artery and allows for better blood is then inflated and the stent is expanded to flow to the heart muscle. Once the artery is press into the wall of the artery. One or more opened, the balloon is removed. stents may be used, depending on the length of the blocked areas. A new tissue lining will You may experience chest pain or pressure form over the stents to keep them in place. when the balloon is inflated. Let the doctor The stent’s job is to keep the artery open so know if you have pain or pressure during or blood can flow through easily, without clotting after the procedure. You will be asked to rank in narrowed passages or on rough edges of the pain on a scale of 0 to 10. Zero is no pain plaque. A patient is usually required to take and 10 is severe, crushing pain. an antiplatelet medicine after a stent is placed.
Coronary Stent Implant Drug-eluting stents have a drug coating that is time-released to help prevent thickening A coronary stent is an expandable, slotted metal and re-blockage (called restenosis) in the tube that is inserted into a coronary artery. It artery walls. This type of stent is not available looks much like a ball-point pen spring and for all types and locations of blockages. Bare acts as a retaining wall to hold the plaque that metal stents also are used routinely. Your was pushed back during angioplasty. It may be cardiologist will determine which type of stent inserted in a coronary artery after the balloon is appropriate for you. During the procedure angioplasty or as an independent procedure. to insert a stent, you may experience chest pain The procedure takes 30 to 90 minutes. or pressure when the balloon is inflated. You need to let the doctor know if you have pain or pressure during or after the procedure. You will be asked to rank the pain on a scale of 0 to 10. Zero is no pain and 10 is severe, crushing pain.
Stent with balloon inflated
Stent is implanted and balloon is withdrawn ©Medtronic
94 Your Diagnosis and Treatment: Coronary Artery Procedures
Supplementary Technologies IVUS (intravascular ultrasound): A procedure used to determine the extent The following are heart technologies that of the blockage in the coronary artery. A may be used in select cases with angioplasty catheter is advanced to the area of blockage, or stents to improve results. and pictures are taken and then measured to help the doctor determine if angioplasty or a Angiojet: stent procedure should be performed. A procedure to remove a blood clot from a coronary artery during a heart attack or Pressure wire: after angioplasty. A catheter with tiny holes A wire that may be used during an angiogram. at the tip is placed at the area of a blood It helps to determine the severity of blood clot, and the clot is pulled back. An angioplasty flow blockages in the coronary arteries by or a stent procedure usually accompanies performing an internal stress test. The wire this procedure. helps the doctor identify if the blockage needs an angioplasty or stent. Rotoblator: A procedure performed to open blocked After Your Angioplasty or arteries by using a catheter that has a high- speed, rotating shaver to grind up plaque Stent Procedure (a deposit of fat and other substances that You may have a closure device placed at the gathers in the lining of the blood vessel). site where the catheter was inserted, but it will depend on the size of the artery and the Cutting balloon: amount of blood thinner you received. You A procedure that may be used on blockages may have to keep the catheter in place for that are resistant to traditional balloon several hours because of blood thinners given angioplasty. This catheter has a balloon and during your procedure. cutters at the tip that allows your doctor to make several small cuts in the plaque. This You will: helps to reduce the plaque and injury to the • have the catheter removed when the blood blood vessel during the angioplasty. thinner has worn off. • follow the same procedures described for Filterwire: “After your cardiac catheterization,” on page 93 A catheter that may be used during an of this section. angioplasty or stent procedure of a coronary bypass graft. The catheter is placed below the blockage, and a small hoop is opened at the end of the catheter to hold and remove debris that may come loose during an angioplasty or stent procedure.
95 Your Diagnosis and Treatment: Coronary Artery Procedures
Laser Technology
Laser technology, which employs a precise cutting tool, is used for two procedures in cardiology: removing pacemaker leads (wires) and opening total blockages in the arteries in the heart or legs.
Pacemaker Lead Removal When a pacemaker lead is inserted into the heart wall, over time the scar tissue inside the heart and vessels will grow around the tip and body of the lead. This makes it impossible to remove the lead by pulling it out. A hollow laser catheter is used to gently cut around the tip and body of the lead so that the old lead can be removed safely, and a new lead can be inserted. The laser is unique for this procedure in that it totally surrounds the old lead and cuts the scar tissue from the lead as it slides down and over the surface of the lead.
Cutting Through Blockages in Heart and Leg Arteries Sometimes a blockage can grow inside of a heart or leg artery to the extent that it will totally block the artery, allowing absolutely no blood to flow through the artery. Over time, the blockage can grow harder and harder, which prevents the doctors from passing anything, such as a balloon catheter, through the blockage. In order to unclog an artery, the doctor has to be able to pass a very thin wire through the blockage. The laser can be used to cut a tiny hole through a blockage inside of a coronary (heart) or leg artery. This will allow the doctor to pass the thin wire through the blockage and eventually unclog the artery using a balloon and/or stent.
96 Your Treatment: Heart Surgery
Your doctor has recommended heart surgery With traditional bypass surgery, the breastbone as the best treatment option for your heart (sternum) is cut to open the chest. You are condition. In many cases, the surgery will be an usually in the hospital for three to five days after surgery. open-heart procedure in which the breastbone is cut open so the surgeon can work on the heart. Bypass surgery is not a cure for coronary Robot-assisted and minimally invasive surgery is artery disease. Plaque (blockages) can form done through multiple, smaller chest and groin in the bypasses. To help keep the bypasses incisions. This eliminates the need to open the open, you will need to control risk factors that breastbone and can be used in some cases. cause coronary artery disease. This includes A member of your health care team will discuss taking your medicines as ordered, exercising to strengthen the heart muscle, controlling with you the type of surgery you will receive. cholesterol by changing your diet and stopping smoking. The most common types of heart surgery include: • Coronary artery bypass surgery • Valve surgery • Septal defect repair • Maze procedure Left Internal Mammary • Transmyocardial revascularization Artery Bypass • Thoracic aortic aneurysm or aortic dissection repair Left Main Artery • Ventricular restoration
Coronary Artery Bypass Surgery (CABG) Left Circumflex Artery Coronary artery disease may be treated with surgery to improve the blood flow to the heart muscle. Bypass surgery uses veins from your legs or arteries from your arms or chest as replacement vessels (grafts). When a vein Left Anterior or an artery from your arm is used, one end Descending is attached to the aorta, and the other end is Artery attached below the blockage to create a detour or bypass. When the chest artery is used, the Right Coronary Artery lower part of the internal mammary artery (left, right or both) is freed from the chest wall and Saphenous Vein attached below the blockage. Bypass
97 Your Treatment: Heart Surgery
Valve Surgery Transcatheter Aortic Valve Replacement Heart valve surgery involves repairing or replacing a non-working valve. With repair, a For some patients, traditional or even minimally ring may be used to tighten a leaking valve, or invasive valve surgery through the chest is a cut may be made to open a valve that is too considered too high-risk. For patients with tight. To replace a valve, the surgeon takes out severe aortic stenosis (narrowing of the valve) the bad valve and replaces it with a tissue valve, who cannot have open-heart surgery, it may either porcine (pig valve), bovine (cow valve) or be possible to place a new heart valve inside human, or a mechanical (metal or plastic) valve. their narrowed aortic valve. This is done through small incisions in the groin, and in With traditional valve surgery, the breastbone some cases a small incision through the left (sternum) is cut to open the chest. You are side of the chest. A tissue valve with a stent usually in the hospital for four to five days around it is placed on a wire and threaded after surgery. into position, then expanded (opened up) inside the narrowed aortic valve. If you are a After surgery, you will take medicines to candidate for this type of aortic valve surgery, support heart function and to prevent clots you and your family will have several meetings from forming on the valve. With a tissue valve, with the cardiologists and surgeons to explain a “blood thinner” (usually Coumadin/warfarin) the procedure in more detail. may be taken for a short time (1½ to 3 months); with a mechanical valve, a blood thinner is Septal Defect Repair needed for the rest of your life. The atrial septum is a wall of tissue that Protecting yourself from infection is important separates the upper chambers of the heart. after you have had valve surgery. Call your An atrial septal defect (ASD) is a hole or opening doctor at the first sign of an infection—fever, in this wall that fails to close during the body’s sore throat, body aches. development before birth. The ventricular septum divides the two lower chambers Keep your teeth and gums healthy. See your (ventricles) of the heart. A ventricular septal dentist twice a year. Tell your dentist that you defect (VSD) is an opening that can be caused have had valve surgery. Also let your dentist by a birth defect or by an extensive heart attack. know if you are taking a blood thinner. During surgery, the opening is covered by a You may need to take an antibiotic before patch or simply closed by sewing the edges other surgeries or procedures (dental work, of the opening together. skin surgery, colonoscopy or other scope procedures). Tell all your health care providers Maze Procedure that you have had valve surgery when you schedule an appointment or procedure. Atrial fibrillation (A-fib) is a common heart rhythm problem found in about 10 percent of Americans older than 60 years of age. With A-fib, the heart’s upper chambers (atria) beat fast and irregularly. Atrial fibrillation can cause people to have trouble with activity, be short of breath or have a stroke. 98 Your Treatment: Heart Surgery
When medications have not worked to stop Repair of Thoracic Aortic atrial fibrillation, the Maze procedure might Aneurysm or Aortic Dissection be right for you. An aneurysm is the widening or bulging of During the Maze procedure, the doctor a weakened area of the wall of an artery. This makes scars on the left and possibly right weakness and widening is usually caused by atria. These scars help block the irregular atherosclerosis (fatty deposits) and high blood electrical signal. The goal is to make your pressure. Infections can also cause them. heart beat more regularly. The success rate for the Maze procedure is 50 to 90 percent. A dissection is a tear in the wall of the aorta. Sometimes it can be three to six months Causes include high blood pressure, birth before you know if it has worked for you. defects or a forceful blow to the chest, such as occurs with hitting a steering wheel in Transmyocardial an accident. Revascularization (TMR) Thoracic aortic aneurysm or dissection in Cardiac chest pain, or angina, occurs when the main artery that carries blood away from the arteries that provide oxygen-rich blood the heart may cause chest, arm or back pain, to the heart muscle become narrow or blocked. shortness of breath, or difficulty swallowing. The pain is a signal that the heart is not getting It may not have any warning signs. The problem enough blood flow. People who suffer from may be near the aortic valve, or it may involve angina may not be able to do their daily the blood vessels that lead to the head and activities or may be awakened at night with arms and affect blood flow to those areas. chest pain. Repair of an aneurysm or dissection in the Angina often can be stopped with medication, aorta involves opening the chest through balloon angioplasty, placement of a stent in the breastbone (sternum) or between the the artery or bypass surgery. For some patients, ribs. The weakened part of the aorta is however, these treatments do not provide replaced or patched. The aortic valve also complete relief from the pain. may need to be replaced if it has been damaged by the aneurysm. TMR is a surgery that uses a powerful carbon dioxide laser to make tiny holes (bloodlines) You are usually in the hospital for four to seven in the heart muscle while the heart is beating. days after aortic surgery. Recovery is similar Bleeding is quickly controlled, and the work to bypass and valve surgery. After surgery, it is of healing begins. This laser procedure important to control the risk factors that led to encourages new blood channels to form the aneurysm or dissection, such as high blood in the heart. pressure and high cholesterol.
Over the next several months, the heart muscle will grow new vessels, increasing the blood flow and decreasing the pain of angina. TMR gives people with chronic angina a chance to improve their quality of life.
99 Your Treatment: Heart Surgery
Surgical Ventricular Restoration Getting Ready for Heart Surgery (Dor Procedure) Before you have heart surgery, you will have After a heart attack, the weakened heart muscle some blood tests, an EKG, and a chest X-ray. may stretch (dilate). When stretched out, the An anesthesiologist will talk with you. heart muscle doesn’t pump as well as it should. The night before your surgery, you will shower To improve the pumping function of the heart, and then wipe with chlorhexidine cloths to get the weakened portion can be removed and the rid of bacteria on your skin. You also will put pumping chamber (ventricle) returned to a more an antibiotic ointment in your nose to get rid normal shape. This re-shaping of the ventricle of bacteria. This nose antibiotic will be given can be done alone or with bypass surgery. to you again the morning of your surgery. The wipes and antibiotic ointment, along with IV The hospital stay and recovery are similar antibiotics, are used to prevent infections. to bypass surgery. Controlling risk factors is important to prevent another heart attack During and after your surgery, your blood sugar that would further weaken the heart muscle. level will go up. This happens even in people who do not have diabetes. Your nurses will Robot-Assisted and Minimally frequently check your blood sugar level by sticking your finger for a drop of blood. They Invasive Heart Surgery will give you insulin for several days, through Some heart surgeries now can be done an IV at first, to keep the blood sugar normal. through several one- to four-inch incisions, This also helps to prevent infection. rather than cutting through the breastbone to reach the heart. The surgeon may use Immediate Concerns after robot-assisted instruments to work through Heart Surgery these smaller openings. Your surgeon will tell you if it is possible to do your surgery this The first thing you will notice when you wake way. With minimally invasive surgery you are up after surgery will be a tube in your throat. usually in the hospital for two to four days Following surgery, the tube helps you with after surgery. The smaller incisions usually breathing. It is connected to a breathing mean a faster recovery. machine called a ventilator.
Just as with traditional heart surgery, When you are able to breathe on your own, controlling risk factors and taking your your nurse will take the tube out. While the medicines are very important for recovery tube is in, you can’t talk and you may feel like and for the long-term health of your heart. you are choking. At first, when you are still somewhat sleepy, your hands will be tied down to keep you from pulling on the tube. Your nurse will give you medicine to help you feel comfortable with the tube.
100 Your Treatment: Heart Surgery
You will have several drainage tubes in your You will be reminded to do your breathing chest. These stay in until the oozing and exercises every hour while you are awake. This drainage from your chest stops, usually by is important to help keep your lungs inflated the second day after surgery. and to prevent pneumonia.
You will have several special IVs that monitor You also will be getting out of bed the first day your blood pressure and the pressure inside after surgery. The nurses will help you get out your heart. These are usually taken out the day of bed for meals and for walks. By the second after surgery. One other IV will be kept in place day after surgery, you will be ready to take a until you are ready to go home. walk in the hallway outside your room.
You will have a heart monitor attached to your It is important to let your nurse know if you chest. This will stay on until you go home. The are having pain. You will be expected to get tube in your bladder (catheter) will be taken out out of bed, walk, and do your breathing on the first or second day after surgery, usually exercises. These things are harder to do if you when your chest tubes come out, when it is have significant pain. By taking pain medicine, easier to walk to the bathroom. you can be comfortable enough to do all activities that prevent problems and help you recover after surgery.
101 Your Treatment: Heart Surgery
The following charts will give you a quick reference on what to expect before surgery, on the day of surgery and during your hospital stay.
Cardiac Surgery Patient Pathway
Before Your Surgery
General Information • You will need to have Pre-Admission Testing (PAT) for lab tests, EKG and chest X-ray. • You will receive information about your surgery and hospital stay. • An anesthesiologist will talk with you. • You will be given a lung exerciser (incentive spirometer). • Practice taking slow, deep breaths several times a day, using your lung exerciser. • Bring your lung exerciser with you to the hospital on your day of surgery. • Report to Same Day Surgery two hours before your scheduled surgery.
Diet • The night before surgery, do not eat or drink after midnight. • Eat a light dinner the night before your surgery. • Take your heart and blood pressure medication with sips of water (less than one-half cup).
Activities at Home • Take a shower the night before surgery using antibacterial soap, then use the chlorhexidine wipes that were given to you. • After your shower, place the nose antibiotic in each nostril as directed. • Put on clean pajamas after your shower. • Get a good night’s sleep.
Discharge Planning • You will need to have an adult (family member or friend) with you for 24 hours a day for the first week (seven days) after you go home. You need a bathroom scale, thermometer and antibacterial soap when you go home. • You may need a shower bench or chair for your showering.
102 Your Treatment: Heart Surgery
Cardiac Surgery Patient Pathway
Day of Surgery
General Information • Staff will show your family the location of the waiting room. • Family members should let the volunteer know if they leave. • Surgery lasts three to six hours. • Your surgeon will talk to your family after surgery. • You will have an ET tube (endotracheal tube)—a tube that goes down your throat and into your lungs to give you oxygen during surgery. • You cannot talk while the ET tube is in place. • The ET tube will be taken out when you are able to breathe completely on your own (two to twelve hours after surgery). • You will be using your lung exerciser every hour after the ET tube is out. • You will be given a stuffed bear to hold to your chest when you cough.
Diet • You will be given ice chips after the ET tube is removed.
Activity • You will be sleepy for the first twelve hours after surgery. • Your nurse may sit you up in bed.
Comfort • You will be given pain medicine through your IV to keep you comfortable. • We will ask you to rate your pain from 0 to 10: “0” means no pain and “10” is the worst pain you can imagine.
After Surgery • You will have temporary wires in your chest for three to four days. • You will have tubes in your chest to drain any excess blood and fluid for one to two days. • You will have a tube in your bladder (Foley catheter) to drain your urine for one to two days.
103 Your Treatment: Heart Surgery
Cardiac Surgery Patient Pathway
Days 1 to 5 After Surgery
General Information • Your family and friends may visit from 8 a.m. to 8 p.m. Your rest is very important; therefore, we suggest short visits. • We recommend two visitors at a time during the first two days or until the patient is feeling better. We monitor each patient’s response to visitors and sometimes suggest fewer if it’s too much for the patient. • Several tubes and catheters will be removed, usually on day one or two. • A surgeon visits every day.
Breathing • You will be using your lung exerciser on your own. Take 10 deep breaths every hour during the day. • Hold your bear to your chest when you cough. • You may still need oxygen.
Diet • Your diet will change quickly from liquids to a regular diet. • The staff will measure what you eat or drink and your urine output. • It is normal to have a poor appetite, but we want you to eat. • Let your nurse know if you have nausea.
Activities • Bathe with help. • Learn how to care for your incisions. • Sit in a chair with help for every meal. • Walk with help three times each day. • Limit lifting to no more than 5 pounds. • Allow for rest between activities.
Comfort • Take pain medication as needed. • Tell your nurse when you need pain medication—for pain rated greater than 4 (on a scale of 1 to 10).
Discharge Planning A Care Coordinator or Social Worker can help: • arrange for services after discharge. • answer insurance questions and provide support.
104 Your Treatment: Heart Surgery
Cardiac Surgery Patient Pathway
Day of Discharge
General Information • You will be given written instructions to refer to at home. • You and your family will learn about diet, exercise, self-care and cardiac rehabilitation.
Breathing • Continue breathing exercises at home, at least 10 repetitions every hour, while you are awake.
Diet • You need good nutrition to help you heal. • After you recover, follow the diet guidelines taught by the dietitian for a heart-smart diet. • Eat small meals more often instead of three big meals.
Activities • Follow the activity plan found in this book. • Do not lift more than 5 pounds if you have had surgery through your sternum (breastbone). • You will be instructed on: • activity progression • returning to work • driving • sexual activity
Comfort • You will be given a prescription for pain medication.
Discharge Planning • A visiting nurse will be arranged for you. • A follow-up appointment should be arranged. • If you have any questions or concerns after discharge, call your surgeon.
105 Your Treatment: Heart Surgery
Managing Your Care at Home Care of Your Arm Incision If your surgery involved taking an artery Care of Your Incision from your forearm: You should wash your incisions daily with • Care for the incision as written above. antibacterial soap and warm water. Avoid • Avoid lifting with that arm. vigorous scrubbing. Because incisions sunburn easily, be sure to protect them from Walking overexposure to sunlight during the first year You will continue your walks when you get after surgery. The scar will pigment more (be home, increasing a little bit every day. (See darker) if exposed to the sun. Do not apply any section on “Exercising for a Healthier Heart.”) lotions, creams, oils, or powders to your incisions unless prescribed by your cardiac surgeon. Walking is important as you build your strength. It should become a habit that will protect your Check your incisions daily. Notify your cardiac heart’s health for the future. surgeon if you notice any of the following:
• Increased tenderness of the incision line. Energy Conservation • Increased redness or swelling around the edges • You will still be tired when you go home. You will of the incision line. need to rest between activities. Plan your day to • Any drainage from the drainage line. allow rest breaks; for example, after your shower, • A persistent fever. before and after your walks, etc. • Share your work with others if it is too hard, Showers: You can take showers when you go if it makes you tired, or if you get short of breath. home. Avoid soaking in baths until your incisions • Sit whenever possible: when you are getting are healed. Avoid extremely hot water. dressed, preparing food in the kitchen, etc. • Listen to your body and rest when you are tired. Care of Your Surgical Leg
If your surgery involved taking a vein from Diabetes Management your leg, follow these guidelines: If you have diabetes, continue to check your • Care for your leg incision as described above. blood sugar at home. Call your primary care • Avoid crossing your legs as this impairs circulation. doctor if your medicines are not controlling • Avoid sitting in one position or standing for your blood sugar. prolonged periods of time (see exercise below). • It is normal to have some swelling in your leg. Elevate your leg on a stool or coffee table when sitting. You can also lie on a couch and elevate your leg on the arm of the couch. Try to get ankles above the knee, and the knee above the heart. • Exercise the leg to pump fluid out of the leg. Flex the feet up and down to feel the calf muscles squeeze. • If you continue to have leg swelling or it becomes worse, call your surgeon.
106 Your Treatment: Heart Surgery
Activities of Daily Living Hold your bear or put your hands between • Turn down the water temperature in the shower or across your chest; do not push up from and limit your shower to five to seven minutes to armrests or pull on something to get up avoid fatigue. (lifting restriction). Use your legs to push up; • Make sure all your supplies are within reach and use a rocking motion if that helps give you not above your head. momentum to get up. • Limit reaching over your head for objects, it makes your heart work harder. If someone helps you get up, have the person • Sit down to put on socks and pants. Bending over hold onto the waist of your pants. Do not let and reaching down can place too much strain on the person pull using your arms. your chest. • Wear comfortable, loose-fitting clothes that do not When getting into a car, sit down first, and then put undue pressure on your incisions. swing your legs in. When getting out, swing • Stop any activity immediately if you feel short of your legs out first, and then stand up. You may breath, notice irregular heartbeats, feel faint or need a pillow to sit on. dizzy, or have chest pain. Rest until the symptoms subside. If they do not subside within 20 minutes, Climbing Stairs call your doctor. • Limit stairs to one or two trips a day at first; increase as your body allows. Lifting • If you have a leg incision, go up stairs with your For four to six weeks, do not lift, push or “good leg” first and go down stairs using the leg pull objects that weigh more than 5 pounds. with the incision first. Examples: car doors, purses (8 to 12 pounds), • Gently hold on to a handrail. Do not pull yourself gallon of milk (8 pounds), children, pets. Slide up with it. objects or use a rolling cart if necessary. • Put a basket near the steps to collect things that need to go with you; have someone else carry it Getting Out of Bed for you (lifting restriction). First roll to your side, slide your feet off the bed and then use your forearm/elbow to gently Checking Your Heart Rate (Pulse) push yourself up to a sitting position. Do not Check your pulse every day; write it on your pull on someone’s arm to get up. Sleeping with activity diary. Use your fingertips to press gently your chest elevated on several pillows may be at your wrist below your thumb or on your neck more comfortable at first and makes it easier between your voice box and the big muscle on to get up. the side of your neck.
When Getting Up From a Seated Position, Use a watch or clock with a second hand Follow These Guidelines: and count the number of beats you feel in 10 • Avoid low or soft chairs. seconds. Multiply this number by six to figure • Use a pillow. the number of beats in one minute. For more • Scoot to the edge of the seat. detailed instructions on taking your pulse, see • Consider a raised toilet seat. the section of this book on “Exercising for a Healthier Heart."
107 Your Treatment: Heart Surgery
Common Concerns After Going Home
It takes four to six weeks to start feeling better. Remember to take all medication as prescribed by your doctor. • If an artery in your chest (the mammary artery), was used during your surgery, you may have some numbness near the chest incision. This is normal. • You may have a lump at the top of your incision. This will go away with time. • You may notice an occasional clicking or sensation in your chest in the first days after surgery. This should occur less often with time and go away completely within the first couple of weeks. If it gets worse, call your surgeon. • You may have muscle pain or tightness in your shoulders and upper back between your shoulder blades. This will get better with time. Travel • No driving for three weeks after you leave Constipation and Poor Appetite the hospital. Being less active and taking pain medication • Put your bear or a pillow between your seat can make you constipated after surgery. belt and your chest for comfort when you are Eat plenty of high-fiber foods like fruits and a passenger for the first few weeks. vegetables (see the section on “Eating with • Limit local rides/drives to 45 minutes. Stop to Your Heart’s Consent”) and drink liquids. An stretch when you are tired. over-the-counter stool softener, laxative, or • When beginning to drive again, avoid long periods enema may be used. of driving, rush hour traffic and bad weather. It is normal to not have much appetite. It takes Visitors several weeks for your appetite to return. • Limit the number of visitors and how long they Many patients notice that their sense of taste stay for the first couple of weeks. You will be tired. is diminished or almost absent. It will return. • Do not allow anyone to visit if they are sick (cough, Some patients even complain of nausea at the fever, sore throat, a cold). You are more likely to smell of food for a week or two after surgery. pick up an infection. A lack of activity also can affect your appetite. Alcohol Try eating five to six small meals each day Alcohol may affect various medicines. You instead of three larger meals. See the nutrition should not drink alcohol until approved by section for ideas to make foods taste better. It your surgeon. takes extra calories and protein to heal wounds. Try to eat a high-protein food with each meal.
108 Your Treatment: Heart Surgery
Good protein sources include: Heart Rhythm—Skipped Beats, • Poultry, fish, or lean meat—try to eat a total Irregular Rhythm of 6 ounces daily. You may notice an occasional skipped beat • Milk (skim or 1%)—try to have 2 cups daily. or you may be more aware of your heartbeat • Reduced-fat cheeses after surgery. This is normal. If you feel more • Egg substitutes and eggs than five skipped beats each minute, call • Yogurt your doctor.
Iron can help rebuild your red blood cells. If you notice a fast, irregular heartbeat that does Vitamin C helps you absorb iron and also is not go away or causes you to feel dizzy or short good to help wounds heal and fight infection. of breath, call your surgeon.
Foods high in iron include: Atrial fibrillation, a rapid, irregular rhythm, is • Fortified cereals sometimes caused by irritation and swelling in • Lean beef, pork, veal, lamb the heart after surgery. It usually lasts for a few • Spinach, chard weeks, and often needs to be controlled with • Lentils, dried beans, and peas medicine during that time. • Lima beans, soybeans, and tofu Depression and Forgetfulness It is normal to feel a wide range of emotions after surgery. Pain, boredom, limits on your activities, and being out of your normal routine can affect the way you feel.
It is common to feel “down” or discouraged after surgery, when you don’t think you are improving as fast as you should. Talk about what is bothering you. Find some activities that you enjoy and are able to do. If the “down” feeling lasts too long, tell your doctor.
It also is common to be forgetful for a while after surgery. A lack of normal sleep and the use of pain medicines can add to your forgetfulness. This should get better in the weeks after surgery. Good sources of Vitamin C: • Citrus fruits and juices (oranges) • Dark green vegetables (broccoli, green peppers, leafy greens) • Tomatoes • Kiwi • Strawberries
109 Your Treatment: Heart Surgery
Sleep Problems Sexual Activity • It’s common to have sleep problems in the weeks Ask your surgeon at your first follow-up visit after heart surgery. You may be more comfortable about resuming sex. Sexual activity is considered sleeping in a recliner chair at first. a moderate exercise. When you can climb • It helps to set a bedtime routine. Go to bed at a two flights of stairs without problems, it is regular time and get up at the same time each day. usually okay to have sex. Rest during the day, but limit naps to one-half hour. • Avoid foods high in sugar at bedtime. Do not Wait one to three hours after a full meal before eat late heavy meals. Try herbal tea at bedtime. sexual activity. Don’t drink alcohol for three Chamomile is a good choice. Avoid caffeine hours before sex. Make sure you are rested. (coffee, tea, cola) in the evening. Don’t use positions that cause you to support • Take your pain medicine one-half hour before your weight with your arms for a long period bedtime to make you more comfortable. of time. • Try a 15-minute hot footbath or a warm shower an hour before bedtime. Ask your loved ones for If you have chest pain, shortness of breath a 10-minute backrub. or skipped heartbeats, stop and rest. • Use earplugs. Darken the room as much as possible. Turn the alarm clock away so you Some medicines can affect sexual activity. If can’t see the numbers glaring during the night. you think this is causing a problem for you, talk • If you are awake and can’t get back to sleep, to your doctor. Do not stop taking a medicine get out of bed and do a task to make your eyes without talking to your doctor first. tired (read a dull book, play solitaire, pick up your knitting or needlework). Don’t turn on the Returning to Work television (it is too stimulating). It will be weeks before you are ready to return to work. It will depend on the type of work you do, your physical condition before surgery, the type of surgery that you had and how well you are healing. Cardiac Rehab can help provide you with the stamina and endurance you need for your workday. Your surgeon will tell you when you can go back to work.
Ask your doctor if you have any work restrictions (e.g., lifting or driving). You may need to provide documentation to your supervisor indicating any work restrictions.
110 Your Treatment: Heart Surgery
When you are back at work, remember: 1. Start slowly. Pace yourself. Returning to work after a major cardiac event is usually very tiring. Try to start back gradually—talk to your manager about working half days for the first week. 2. Make exercise part of your daily routine. Talk to your doctor about Cardiac Rehab. For more information, see “Lifestyle Changes for a Healthier Heart.” 3. Remember nutrition. Look for heart-healthy eating options at work. If your company has a cafeteria, ask the staff what healthy nutrition choices they offer. If you eat out for lunch, ask the restaurants for a breakdown of the nutrition Guidelines for Family Members content of their menu items. Packing your own Heart disease and heart surgery affect the lunch is the easiest way to ensure you get the whole family. Things may change at home. nutrients you need without the fat and sodium Chores may have to be done by someone you want to avoid. who usually does not do them and roles may be switched. 4. Combine diet and exercise by walking past the vending machines. Bring an extra piece of fruit It is normal to be tired, anxious, scared, from home instead of purchasing a less-healthy confused, angry, sad, helpless and even snack from the vending machine at work. depressed after having a family member go through heart surgery and then dealing with changes at home. These feelings are not “bad” or “wrong.” Talk about how you feel. Naming your feelings gives you some control over them.
It is important to take care of yourself while you are helping a loved one heal: • Eat a healthy, balanced diet. • Get some rest; nap when your “patient” naps. • Take a walk. • Practice deep breathing or other relaxing exercises. • Accept help from family and friends. Don’t be afraid to ask for help. • Talk with a trusted friend or someone who also has been through this. • Take the phone off the hook or let the answering machine take over for a while.
111 Your Treatment: Heart Surgery
When To Resume Usual Activities
First 6 Weeks After 6 Weeks After 3 Months
Light housekeeping (dusting, Continue activities Continue activities setting the table, washing of first six weeks (but of one to three dishes, folding clothes) you may be able to months (but you tolerate more) may be able to Light gardening tolerate more) (potting plants, Return to work part- trimming flowers) time if your job does Heavy housework not require lifting, and (scrubbing floors) Needlework, reading returning is approved by your surgeon Heavy gardening Cooking meals (shoveling snow, Heavy housework digging) Climbing stairs (vacuuming, sweeping, laundry) Sports: football, Small mechanical jobs soccer, softball, Heavy gardening baseball, tennis, Shopping (mowing lawn, bowling, golfing, raking leaves) swimming, water Attending sports events, skiing, skydiving, church, movies, and Ironing hunting restaurants Business or Jogging, bicycling Passenger in car recreational travel Weight-lifting, Walking Fishing, boating push-ups
Shampooing hair Light aerobics Motorcycle riding (no weights) Playing cards/games Walking dog on leash
Driving a car or small truck
Treadmill, stationary bike (only after you start rehab)
112 Your Treatment: Heart Surgery
Daily Activity Log for Open-Heart Surgery Patients
Week 1 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Dates:
Walk 1 3 min. 4 min. 5 min. 6 min. 7 min. 8 min. 9 min. Walk 2 3 min. 4 min. 5 min. 6 min. 7 min. 8 min. 9 min. Walk 3 3 min. 4 min. 5 min. 6 min. 7 min. 8 min. 9 min. Walk 4 3 min. 4 min. 5 min.
Breathing Exercises: 10x each hour
Weight: Call doctor if you’ve gained 2 lbs/day or 5 lbs/week
Heart rate at rest: Call doctor if <50 or >110 beats per minute
Check temperature in morning. Call doctor if above 100.6° F
Finger stick blood sugars
113 Your Treatment: Heart Surgery
Daily Activity Log for Open-Heart Surgery Patients
Week 2 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Dates:
Walk 1 10 min. 11 min. 12 min. 13 min. 14 min. 15 min. 16 min. Walk 2 10 min. 11 min. 12 min. 13 min. 14 min. 15 min. 16 min. Walk 3 10 min.
Breathing Exercises: 10x each hour
Weight: Call doctor if you’ve gained 2 lbs/day or 5 lbs/week
Heart rate at rest: Call doctor if <50 or >110 beats per minute
Check temperature in morning. Call doctor if above 100.6° F
Finger stick blood sugars
114 Your Treatment: Heart Surgery
Daily Activity Log for Open-Heart Surgery Patients
Week 3 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Dates:
Walk 1 17 min. 18 min. 19 min. 20 min. 21 min. 22 min. 23 min.
Breathing Exercises: 10x each hour
Weight: Call doctor if you’ve gained 2 lbs/day or 5 lbs/week
Heart rate at rest: Call doctor if <50 or >110 beats per minute
Check temperature in morning. Call doctor if above 100.6° F
Finger stick blood sugars
115 Your Treatment: Heart Surgery
Daily Activity Log for Open-Heart Surgery Patients
Week 4 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Dates:
Walk 1 24 min. 25 min. 26 min. 27 min. 28 min. 29 min. 30 min.
Breathing Exercises: 10x each hour
Weight: Call doctor if you’ve gained 2 lbs/day or 5 lbs/week
Heart rate at rest: Call doctor if <50 or >110 beats per minute
Check temperature in morning. Call doctor if above 100.6° F
Finger stick blood sugars
116 Heart Surgery: Information for the Family
Your loved one has chosen a TriHealth hospital possible, when the patient’s vital signs are stable, for heart surgery. The following will answer the family will be invited back for a brief visit. many questions that your family may have The patient will not be awake, nor will he or she awaken until the medicines from surgery wear about surgery and postoperative care. off. This could take a few hours.
We will do our very best to make you and What Will You See? your loved one as comfortable as possible during and after his or her stay. After surgery, your loved one will be pale and swollen from the fluids that were given during During Surgery surgery. You will notice a tube in his or her mouth called an endotracheal (breathing) You will wait in the Surgery Waiting Room while tube. It is connected to a breathing machine your loved one is in surgery. You will be notified called a ventilator. about key events during the surgery, but there may be a period of several hours with no new The patient also will be connected to a heart information from the operating room. When monitor. This measures the heartbeat and surgery is complete, the patient will be moved vital signs, such as blood pressure and oxygen to an open-heart unit, and you will be directed level. The nurse will explain the various pieces or escorted to a private room where you will of equipment used to monitor the patient. The meet with the surgeon. tubes (chest tubes) coming out of the chest drain blood and fluid away from the surgical site. The Open-Heart Unit Temporary pacing wires may be placed in the chest in case the heartbeat slows temporarily. The open-heart unit at Bethesda North Hospital A catheter will be placed in the bladder to drain is called the Cardiovascular Intensive Care Unit, urine. Special air pressure pumps (SCD pumps) or CVICU. It is located on the first floor of the will be on one or both of the legs to help prevent hospital, very close to the operating room. blood clots. One or more IVs will give the patient the fluids and medicines needed at this time. The open-heart unit at Good Samaritan Hospital is called the Cardiac Surgery Unit All of the equipment and monitors are routine (CSU), located on 7Q. for patients after heart surgery.
As soon as surgery is over, your loved one will Soft wrist restraints may be on the patient’s be wheeled into this nursing unit and remain wrists as long as the ventilator is needed. These there until discharge from the hospital. are a gentle reminder not to pull on monitoring lines or tubes. The nurse will remove them as When Can You Visit? soon as possible.
After surgery, it will take about an hour before you can see your loved one. During that early recovery period, the staff must focus completely on the patient. We understand how stressful this day is on family members. As soon as safely
117 Heart Surgery: Information for the Family
The Family Spokesperson What Happens the Day After Surgery? While you are in the open-heart unit, the nurse will ask you to select a family spokesperson. On the morning after surgery, we ask visitors This is the person who can be relied upon to to come in after 10 a.m. Many of the tubes relay information about the patient to other and IVs will be removed before this time. The people who need to know about the patient’s patient will need to rest after this and perhaps condition. This helps maintain confidentiality have something to eat before seeing visitors. for the patient and allows the nurse to best take care of the patient. For updates, family members From this point on, the goal will be to increase should call the designated spokesperson rather the patient’s activity. The more active the than the hospital. patient is after surgery, usually the sooner he or she will be able to go home. After Your First Post-Surgery Visit Visiting Hours After this visit, we suggest that you leave the hospital for a break to get food, rest and a Short visits are always best. Normal hospital change of pace. Most families prefer to go visiting hours are from 8 a.m. until 8 p.m. home and return the next morning when the We have found, however, that heart surgery patient is more alert. patients need rest in the afternoon; there will be a period of quiet when we try to limit activity Throughout this first day post-surgery, the and visits. We ask friends and family to help nurse will be very busy caring for your loved our patient care unit to be quiet and restful at one, managing pain, blood pressure, heart rate, all times. bleeding and breathing. As the patient wakes up after surgery, he or she is usually confused. Since the patient may be out of the hospital Ventilator breathing is not comfortable. The in a few days, we suggest that only immediate patient may feel as if he or she is not getting family members and close friends visit. Instead enough air. The nurse monitors the oxygen of making long visits, we recommend that you levels carefully to ensure that the patient is use this time to rest and prepare for the patient’s actually getting enough air. The calmer the return home. For health reasons, no children patient remains, the sooner the breathing under the age of 14 are allowed to visit. Please tube can be removed. The nurse will attempt do not visit if you feel sick, have a cough, fever to get the patient off of the ventilator as soon or sore throat. When visiting at Bethesda North, as possible. How long a patient remains on a use the phone in the Critical Care Waiting Room ventilator depends not only on the patient’s to call before coming into the unit. low anxiety level but also on the condition of the lungs before surgery, smoking history, Check with Nurse Before Giving Fluids. and the amount of pain medication needed. Before giving any fluids, it is very important to check first with the nurse. Extra fluids can be stressful to the recovering heart. The patient will feel thirsty, but drinking water may not be satisfying. You may bring in sugar-free mints or lemon drops to relieve the thirst.
118 Heart Surgery: Information for the Family
Pain Management Medication Side Effects Occasionally, patients have side effects such Patients will experience pain after surgery. as hallucinations (seeing things that are not The goal for pain management is to control there) or paranoia (feeling as if someone is the discomfort so that the patient can actively going to hurt them). If the patient experiences participate in the gradual increase in activity any odd or bad effects, let the nurse know right necessary for recovery and discharge to home away. The sooner we know there is a problem, or a rehab facility. the sooner we can get the patient a different medication that will minimize these side effects. Breathing well and doing the breathing When pain medications are taken properly, exercises are very important. These will help there is no reason to fear addiction to them. prevent pneumonia or other lung problems. Preparing for Discharge We use a 0 to 10 scale to measure pain. Zero is the lowest sensation of pain and 10 is the At Bethesda North, the Cardiac Education highest. Pain levels of 1 to 4 are considered personnel hold discharge classes on Monday, normal and tolerable after surgery. Our Wednesday and Friday at 10:30 a.m. Discharge nurses will check with the patient frequently class is given for the patient and the family to evaluate the patient’s level of discomfort members immediately involved with patient and teach the patient methods of controlling care after discharge. and managing pain, as well as providing medications to keep pain at a tolerable level. At Good Samaritan, discharge education begins the day after surgery and continues throughout The majority of discomfort occurs the first two the hospital stay. We will review many things days after surgery, mostly due to the chest with you in the days after surgery and summarize tubes. Most patients describe this as tightness them again on the day of discharge. The usual or tension in the chest. Many describe a length of stay in our unit is three to five days. discomfort under the shoulder blade. After discharge, patients must have an adult It is important to keep pain under control stay with them for 24 hours a day for the first without giving too much medication. Too week. If family or friends are not available much pain medication could limit the patient’s to care for the patient when he or she goes breathing or cause other problems that could home, tell your nurse as soon as possible. We slow down recovery. recommend you bring clothes for the patient to go home on the second day after surgery. Discuss the amount of pain the patient is We suggest pants with an elastic waist and experiencing with the nurse and doctor. They a loose-fitting top. A shirt that opens in the may change medications to keep the patient front is best. comfortable or to minimize side effects.
119 Heart Surgery: Information for the Family
In the Home Questions
You will need the following equipment Heart surgery can be very stressful for the at home: family. Many questions, feelings and concerns • thermometer can be answered by the nurse, the doctor • bathroom scale or the chaplain. We suggest you write your • antibacterial soap questions here so that you can get answers • non-slip mat for the tub and/or to all of them. something sturdy for the patient to sit on while showering • extra pillows
Follow-up Visit at Home A home care nurse will visit the patient one to two days after discharge from the hospital. The nurse may arrange for one or more follow-up visits if needed.
Please let us know how we can help you further during your time with us.
120 Electrical Problems of the Heart
Your heart’s pumping action is regulated by An electrophysiology study (EPS) provides electrical impulses, telling the heart chambers a more in-depth examination of your heart’s when to contract. When the heart pumps too electrical system. The study measures exactly how the electrical impulses flow through your quickly or too slowly, or without a steady heart during a heartbeat. rhythm, the body may not receive the blood it needs to function. Abnormal heart rates may cause symptoms such as faintness, dizziness, lightheadedness, nausea, fatigue, shortness of breath and anxiety. Devices such as pacemakers and implantable cardiac defibrillators are able to identify abnormal rhythms and correct them so the rhythm returns to normal. 3
The heart’s pumping action is controlled by 1 an electrical system that sends out impulses, or signals. An electrical signal starts in the right 2 atrium in the sinus node (also called the sino- 4 5 atrial node). The sinus node tells the top of the 7 heart (atria) when and how fast to pump. It is 6 the “pacemaker” of the heart. The signal is then sent to the atrioventricular node (AV node) in the middle of the heart. The AV node holds the signal until the bottom chambers of the heart (ventricles) are filled with blood. It then sends the signal to the ventricles through a conduction pathway of specialized fibers that tell the ventricles to pump the blood out to the The Heart’s Electrical Pathway body. If the heart’s chambers are contracting 1. Sinus node too quickly or too slowly, the heart cannot 2. Right atrium pump blood efficiently. 3. Left atrium 4. AV node Diagnosis of Your Heart Problem 5. Impulses spread through ventricles Electrophysiology is a branch of cardiology 6. Right ventricle that focuses on electrical problems of the 7. Left ventricle heart that cause abnormal rhythms. One of the most common diagnostic tests for testing heart rhythms is the electrocardiogram, more commonly called an EKG. The EKG creates a picture of the electrical activity of your heart, as sensed from the surface of your skin.
121 Electrical Problems of the Heart
The physician, an electrophysiologist, will physician will be able to identify an appropriate place two or more temporary catheters into treatment for your specific arrhythmia. The the different chambers of your heart. pacing catheters are removed at the end of the procedure. A catheter is a thin, insulated tube with tiny wires inside. These catheters are usually inserted By identifying problem areas, your doctor through the veins in your upper leg, neck or can recommend therapies to help prevent arm areas. life-threatening conditions such as cardiac arrest, in which the heart beats very fast or stops completely. Timely treatment also may prevent sudden cardiac death, which usually Neck insertion site is caused by ventricular tachycardia or ventricular fibrillation.
Arm insertion site Some of the most common conditions identified by an EPS include:
Arrhythmia, a heart rate that is faster or slower than the average heart rate.
Bradycardia, a slow heartbeat, less than 60 Wrist insertion site beats per minute. This can be caused by the sino-atrial node not working properly or by a blockage of the electrical pathways of the heart. Groin insertion site Supraventricular tachycardia (SVT), a fast heartbeat in the upper chamber of the heart.
Catheter Ventricular tachycardia (V-Tach) is a fast heartbeat caused by an abnormal impulse coming from a single area of the ventricle. The rapid rate of 120 to 250 beats per minute may produce dizziness, weakness and unconsciousness.
They allow the physician to record the electrical Ventricular fibrillation (V-Fib) is a very fast, impulses in your heart and to pace your heart irregular heart rate caused by electrical short- at a faster rate to reproduce the abnormal circuiting in the ventricle. The heart beats so rhythm or symptoms that you have experienced. fast that it is not able to pump any blood to The physician will be able to see the actual the body. A heart in fibrillation may beat more recording of your heart’s electrical activity than 300 times a minute. The person will pass and be able to determine where the abnormal out and need immediate attention. activity is occurring. With this information, your
122 Electrical Problems of the Heart
Before Your After Your Electrophysiology Study Electrophysiology Study
You will: You may have a closure device at the site where • have been told not to eat or drink anything after the doctor inserted the catheters, if the artery midnight, except for your medications with a small was used and if the incision is large enough for sip of water. a device. You will be given written information • be asked to sign a consent form for the procedure on this. and for sedation. • have blood work and your medical history checked You will: by the staff admitting you. • be moved off the procedure table to a recovery area. • have the hair clipped at the area where the doctor • be placed on a heart monitor, have an automatic will be working. This area could be the groin, neck blood pressure cuff placed on your arm and an or upper chest. The most common site is the groin. oxygen monitor (a finger clip) placed on a finger. • be taken to the procedure room, where two • be asked to empty your bladder at this time. to three staff members will be preparing for • have the catheter removed from the site and have your procedure. firm pressure applied for 10 to 20 minutes. This is to • be placed on a heart monitor, have a clip placed prevent bleeding. on your finger or toe to read your blood’s oxygen • have your blood pressure checked by a nurse every level, and have a blood pressure cuff placed on 15 minutes for the first hour. your arm that inflates automatically. • have a bandage applied to the site. • have the area where the doctor will be working • need to tell the staff right away if you feel a cleaned with a special soap and covered with a warm, wet feeling at the catheter site; you could sterile sheet. be bleeding. • be asked to keep your arms under the sterile sheet • be on bed rest for one to two hours. and to not bend or move your legs. • put your hand over the bandage and press firmly • be given medicine through your IV to help you if you have to cough or sneeze. relax. You may become very sleepy. • possibly have a bruise at the site. This is normal. • be given medicine by the doctor to numb the area • possibly feel a lump at the site. If it is walnut-sized where he or she will be putting the catheters into or bigger, let the nurse know. the vein or artery. The doctor will position the • have pain medicine available. catheters in your heart to record your internal EKG. • go back to your room and, at the time of discharge, be given instructions for what to do when you go If you have a normal electrophysiology study, home, including eating, activities, medications, etc. no further treatment will be recommended. If the EPS reveals a problem, your doctor may recommend an ablation or implant procedure to correct any irregular heartbeats. Your doctor also may prescribe medical treatment.
123 Electrical Problems of the Heart
Electrophysiology • Wolff-Parkinson-White (WPW) syndrome, in which Interventional Procedures an extra pathway connects the atria and ventricles. Impulses passing through the ventricles may travel Ablation along this extra pathway back to the atria. The Catheter ablation is a minimally invasive impulses from the extra pathway can make the procedure that can be used when medications atria beat faster or allow impulses to move into fail to control the heart rhythm. Catheters are the ventricles too quickly, possibly causing a inserted in the femoral vein or subclavian vein dangerous arrhythmia. and threaded to the heart to locate where the abnormal heart rate is starting. The doctor Ablation for Atrial Fibrillation will pinpoint the location and insert a special The most common source of atrial fibrillation catheter so the tip of the catheter touches is tissue located around the pulmonary veins. the area. Energy waves will be sent through The pulmonary veins are large blood vessels the catheter to destroy (ablate) the tissue at that carry blood from the lungs to the left atrium. the problem area. The goal is to restore your In ablation for atrial fibrillation, the doctor isolates rhythm to normal. This procedure may last the pulmonary veins from the rest of the heart two to four hours. muscle. This is called pulmonary vein isolation. There are two different methods to do this: Common arrhythmias that may be treated One method uses energy waves to apply heat with an ablation procedure include: to the tissue. This is called radiofrequency (RF) • AV nodal re-entrant tachycardia (also called ablation. The other method applies cold and supraventricular tachycardia), in which impulses is called cryoablation. Both types of ablation traveling through the AV node may get trapped in result in scar tissue around the pulmonary an extra pathway that lies in or near the AV node. veins. Some patients require additional ablation The trapped impulses make the atria beat faster. procedures. You will still be taking a blood • Tachycardia caused by an accessory (extra) thinner and medications for your heart rhythm. pathway. • Atrial fibrillation, in which the atria receive extra impulses from multiple short circuits, causing Cardioversion them to contract more quickly and unevenly. Cardioversion is a procedure to make an Sometimes they beat so fast and unevenly that abnormal heartbeat return to normal. An they stop contracting and begin to quiver. electric current is sent through pads placed • Atrial flutter, a condition in which the atria have on your skin to your heart. Before the a large short circuit. Impulses loop around and procedure starts, you will be given medicine around inside this circuit. These impulses tell the through your IV to put you to sleep. atria to beat very fast. • Ventricular tachycardia, a fast heartbeat caused After the procedure, you may notice that the by short circuits in the ventricle resulting from skin is red and sore (like a sunburn) where the previous scarring. pads were. Your doctor may order an ointment for you to put on this slight burn from the electrical current.
124 Electrical Problems of the Heart
Treatment for Irregular Pacemaker Heart Rhythms generator
Treatment options for irregular heartbeats include implanting devices to regulate the heart and performing interventional procedures on the heart to alter abnormal function.
For life-threatening heart rhythms, a defibrillator may be used to stop extremely leads rapid and irregular heartbeats and return the heartbeat to normal. A defibrillator is an external or internal device that can deliver an electric shock to re-set the heart rhythm.
Permanent Pacemaker A permanent pacemaker is a small, lightweight electronic device that is placed in your upper chest through a small incision. The pacemaker consists of a generator and leads. The leads allow the generator to monitor your heart rhythm and to send out electrical impulses to make Internal Cardioverter Defibrillator (ICD) your heart beat when needed. Some problems An internal cardioverter defibrillator (ICD) is that may require a pacemaker include: a small, lightweight electronic device that is placed in your upper chest through a small • Failure of the sino-atrial node to send out incision. It keeps track of your rhythm. When an impulse, resulting in a slow heart rate. you have an arrhythmia, the ICD helps your • A block in or below the AV node which prevents rhythm return to normal by either pacing the impulse from the sino-atrial node from or delivering a small shock to your heart. reaching the lower chambers (ventricles) of the heart. Your doctor will program the defibrillator • Abnormal heart rhythms that are not controlled to automatically treat your arrhythmia. by medications.
Your pacemaker implant will take place in the ICDs are recommended if you have had a electrophysiology lab. You will have a team cardiac arrest or if you have a fast heart rhythm of people assisting with this procedure. The problem that could lead to cardiac arrest. The team includes a doctor, nurses and technicians. ICD is not a cure but it can save your life by quickly stopping a dangerous rhythm.
125 Electrical Problems of the Heart
The defibrillator system has two parts: Heart Failure Therapy a generator and leads. A special pacemaker or ICD can be implanted The generator (defibrillator) is a smooth, to help the heart pump more efficiently by lightweight metal case containing a tiny coordinating the left and right ventricular computer and a battery. It is the size of contractions. The ICD and pacemaker a pager. The generator does the following: are referred to as a biventricular ICD or • keeps track of your heart rhythm biventricular pacemaker. These devices also • sends out electrical pulses and shocks will treat abnormal heart rhythms by either when needed pacing or delivering a small shock to stop • records your heart rhythm rapid and irregular heartbeats. These devices • records the pulses and shocks the ICD are used in patients with heart failure. sends out These newer devices are referred to as The leads are small wires covered with a cardiac resynchronization therapy (CRT). CRT soft flexible plastic that are connected to resynchronizes the contractions of the heart’s the generator. The leads are inserted through left ventricle by sending tiny electrical impulses a vein and placed inside your heart. Leads to the heart muscle, which can help the heart do the following: pump blood throughout the body more • help the generator keep track of and record efficiently and reduce heart failure symptoms. your heart rhythm Another CRT device has the ability to monitor • carry pulses and shocks from the generator thoracic fluid accumulation. This device allows to the heart physicians to monitor a patient’s status and The shocks that are sent by the ICD can be mild adjust medications. The goal is to prevent or strong and may feel briefly uncomfortable. patients from being readmitted to the hospital. They will not harm your body and they won’t shock anyone near you.
126 Electrical Problems of the Heart
Before your pacemaker/ICD implant you will: After your pacemaker/ICD implant you will: • have been told not to eat or drink anything after • be moved off the procedure table to a recovery midnight, except for your medications with a small area or back to your room. sip of water (one fourth of a cup). • be placed on a heart monitor, have an automatic • be asked to sign a consent form for the procedure blood pressure cuff placed on your arm and an and for sedation. oxygen monitor (a finger clip) placed on a finger. • have blood work and your medical history checked • need to limit the movement of your arm on the by the staff admitting you. side of the implant for the first 24 to 72 hours. • have the hair on your chest clipped and cleaned • have pain medicine available. with a solution. • be given written instructions at the time • be taken to the procedure room, where you will of discharge for what to do when you go home, have two to three staff members preparing for including eating, activities, medications, etc. your procedure. • be placed on a heart monitor, have a clip placed on your finger or toe to read your blood’s oxygen lead generator level, and have a blood pressure cuff placed on your arm that inflates automatically. • have the area where the doctor will be working cleaned with a special soap and covered with a sterile sheet. • be asked to keep your arms under the sterile sheet and to not bend or move your legs. • be given medicine through your IV to help you relax. You may become very sleepy. • be given medicine by the doctor to numb the area where he will be inserting the pacemaker/ICD. • have an incision about one to three inches long for the insertion of the generator. • have leads threaded through a vein to your heart and connected to the generator. • have the generator placed just under the skin. This is called a “pocket.” • have the generator and leads tested by the physician and programmed at that time for your specific need. • have the incision closed with stitches and covered with steri-strips and a bandage.
The procedure will take one to two hours, and the doctor will talk with your family when the procedure is finished.
127 Electrical Problems of the Heart
Notes:
128 Diabetes Management
Diabetes is a lifelong disease that can have Eat smart. serious consequences for the heart and blood Certain foods will help to keep your blood vessels. Complications from diabetes include sugar in control. A visit with a dietitian is very coronary artery disease, high blood pressure, important. A dietitian will teach you how to eat well-balanced meals and snacks. Smart eating high cholesterol and blockages in the blood is a good way to lose extra weight. This will vessels that may lead to amputation. With help your body use insulin better. proper management of your disease, however, you can greatly reduce the risk of further Exercise regularly. damage to your heart and blood vessels. The Exercise helps you lose weight and keep your following guidelines will help you in your blood sugar well controlled. It also helps your journey to recovery and wellness. cardiovascular system. For the person with diabetes, exercise is as important as diet and Diabetes is a disease in which you have too medication. It is recommended to exercise at much sugar in your blood. When you have least 30 minutes a day most days of the week. Type 1 diabetes, your body can no longer make insulin, a chemical that lets the sugar get into Test your blood sugar regularly. your cells to give you energy. Monitoring your sugar every day is the only way that you know how well you are taking care of Type 2 diabetes often is linked to being your diabetes. You can no longer depend on overweight and inactive. Your body still makes the way you feel to tell you whether your blood some insulin. Either your cells resist the insulin, sugar is well controlled. or you may not make enough insulin. You may be able to control your blood sugar with diet Take your medication as prescribed. and exercise. Some people may need to take Talk with your health care provider or pharmacist pills to control their sugar, and some people to learn the best time of day to take your may need to use insulin shots. medicine so that you get the greatest benefit from your pills or insulin. There is a link between diabetes and heart disease. High blood sugar acts like sandpaper, Eat Smart and causes the walls of the arteries to become rough. This allows “bad” cholesterol to build up Smart eating is the first step in taking care of in the walls of an artery, causing more plaque. your diabetes. You do not need special or diet Controlling your blood sugar can help slow or foods. Food that is good for you is also good prevent this damage. for the whole family. The types and amounts of foods you eat every day will make a big Self Care difference in your blood sugar.
Diabetes is a chronic disease and currently Your body makes sugar from the carbohydrates cannot be cured. However, when managed you eat. Carbohydrates are starches and complex properly, you can prevent damage to the sugars. They include foods made with flour or tissues in your body. sugar, rice, and certain vegetables, such as corn, peas and potatoes.
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Basic Guidelines for a Healthy Diabetic Diet Sugar alcohols (sorbitol, mannitol, xylitol) 1. Eat three balanced meals each day. Meals should occasionally can be used in small amounts. include protein (meat, cheese, fish, poultry, eggs, They have about the same amount of calories peanut butter or tofu), and high-fiber foods such as table sugar. When used in large amounts, as fresh fruit, vegetables, whole grains and beans. they can cause diarrhea and cramps. 2. Have a small evening snack before bedtime. It Sugar-Free and Diet Foods should contain protein, such as low-fat cheese and crackers, or half a sandwich. If a food is advertised as “sugar free” it has very little or no sugar, but it may still be high 3. Eat about the same amount of food each day. in fat and calories, and may still contain Watch your portion sizes. Do not take second carbohydrates—be cautious and read the label. helpings. Also be careful with foods labeled “reduced” or 4. Meals should be four to five hours apart. Do not “less.” They may have less sugar or calories than skip meals. If meals are delayed, eat a small snack. the regular products, but may still raise blood 5. Eat less fat. Use low-fat cooking methods like sugar levels. baking, roasting, broiling, grilling, poaching, steaming, or boiling, instead of frying. 6. Sweets such as cake, ice cream or cookies should be eaten less often. When eaten, they should be part of the meal, and not as an extra snack. 7. Limit alcohol (beer, wine, and liquor) to one or two servings per day. 8. Try to lose weight if you are overweight. Even small amounts of weight loss can make a big difference in your blood sugar control. 9. Use the Nutrition Facts panel on food labels to help you make healthier food choices. Select foods that are low in fat and high in fiber.
Examples of non-nutritive sweeteners that are approved for use by the Food and Drug Administration (FDA) are: Saccharin (Sweet & Low) Aspartame (Equal, NutraSweet) Acesulfame (Sweet One) Sucralose (Splenda) Stevia (Truvia)
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Testing Your Blood Sugar Heart disease strikes people with diabetes To keep your blood sugar as close to normal twice as often as those who don’t have as possible, you must test your blood sugar diabetes. Lower your risk of heart disease frequently. Other terms for this are monitoring and stroke by following the ABCs of your blood sugar or blood glucose. Obtain diabetes management: a blood glucose monitor that you can use yourself at home after you are discharged. A: A1c test. Have this blood test every The nurse will show you and/or your family three to six months. how to use the monitor so that you can B: Blood Pressure. Check at every regularly test your blood sugar. doctor’s visit. We recommend that you test four times a C: Cholesterol level. Check at least once day your first week home from the hospital. a year. Generally, you should test right before each meal and before you go to bed. Your doctor You can reduce your risk for complications or nurse will tell you what schedule you should if you are educated about your disease, use. Be certain you haven’t had anything to learn and practice the skills necessary to eat for two hours before you test so that your better control your blood glucose, blood results are accurate. If you have eaten within pressure and cholesterol levels, and receive two hours, your blood sugar may be high. regular checkups.
Your blood glucose goals are: • Before breakfast (fasting): 70 to 110 A1c • Before meals: less than 120 There is a second blood test that shows how • Two hours after meals: 70 to 140 well your diabetes is controlled. An A1c blood • Bedtime: 100 to 140 test measures your average blood sugar levels over a two- to three-month period to tell you Call your primary care doctor (family doctor) if your current treatment plan is working as it if your sugar stays above 160 each time you should. Based on the results of this test, your test it during a 24-hour period. doctor may make changes in your medication. This test gives results over a longer time than When your sugar stays above these goals, your daily blood sugar readings. It also helps predict healing is much slower. If you had surgery, you risk for heart disease and other problems. are at a greater risk of getting an infection in The level for people with diabetes should be one of your incisions. It is very important that less than 6.5 percent. Your treatment may be your blood sugar remains within these ranges. changed if the level is higher. You should have this test done every three to six months.
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Helpful Hints for Any time your treatment changes you should Blood Sugar Testing test more often. When you take pills to control your blood sugar, you should test two hours Be sure you know how to use your meter after you eat. This will tell you if your blood and that the batteries in your meter are good. sugar is going too high when you eat. Your Most meters will give you a picture of a battery doctor wants to know this so that he or she on the display screen when the batteries are can adjust your medicine if your sugar is too getting weak. high after meals.
Check your strips to be sure that they haven’t expired. Strips are sensitive to light, heat and moisture. Keep them in their original container until you are ready to use them.
If your meter requires calibration, make certain that the number in the meter matches the number on your strip container. Refer to your meter instruction manual for changing this number.
Wash your hands in warm soapy water before your test. Clean, warm hands will make it easier to get a good drop of blood.
Be sure you follow the directions for your meter when you test your sugar. It is important that you do the test exactly the way the maker of your meter tells you to do it.
Write your blood sugar results in your diary. Take the diary with you to your regular doctor appointments so that the doctor or the diabetes educator can review and discuss your results When you’re going to be away from home at with you. This will help you see how your the time when you are supposed to test, take meals, activity and medicines work together your meter with you. Don’t leave your meter to control your sugar. in your hot car during the summer months, or out in the cold during the winter.
Remember, regular blood glucose testing helps you make decisions about your meals and exercise. It is your key to better control.
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Diabetes Medications Side effects may occur when you start taking your diabetes pills but will usually go away Type 1 Diabetes within a few weeks. Nausea or increased “gas” People with Type 1 diabetes must take insulin. are common side effects that should last only You must test your blood sugar regularly so you a short time. Call your doctor if you have can make decisions about your insulin dose. vomiting, skin rash, acne, hives or dizziness. Talk this over with your doctor or diabetes educator so that you learn how to adjust your insulin dose depending on your blood sugar results, planned activities, or meals.
There are various types of insulin. Your doctor will help you decide which type of insulin will be best for you and your lifestyle. Remember to be flexible, because your insulin type and dose may need to be changed at times. Take your insulin at the same time every day. Try not to change the time you take it by more than one hour. Some insulins are taken before meals. Be sure you know how soon you should eat after taking your insulin. Your doctor may tell you to take your insulin at bedtime. It is especially important that you take this insulin at the same time each night, because it is designed to last 24 hours.
Type 2 Diabetes When you have Type 2 diabetes, you may be able to control your blood sugar by your diet Oral Medications for alone. Many people with Type 2 diabetes, Type 2 Diabetes however, need to take medication. Pills for Sulfonylureas diabetes are not insulin. They are simply pills that work to make your body produce more Glipizide (Glucotrol, Glucotrol XL) insulin, or help your cells use insulin. Glyburide (Diabeta, Micronase) Glyburide micronized (Glynase) Take the medicine exactly as it is prescribed. Glimepiride (Amaryl) Some pills work best if they are taken before meals, and some should be taken with food. These medicines help your body make insulin. Other medicines for diabetes are taken only if Take your medicine 30 minutes before meals. you’re going to have a meal. You have to know If you are allergic to sulfa, you usually cannot when to take your pills, how many to take and take a sulfonylurea. how often you are supposed to take them.
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Biguanides DPP-4 Inhibitors Metformin (Glucophage, Glucophage XR, Sitagliptin Phosphate (Januvia) Glumetza) Saxigliptin (Onglyza) Linagliptin (Tradjenta) Metformin may help with weight problems because it helps the body use insulin better. These medications increase the release of It can cause nausea or diarrhea in some insulin and decrease the release of glucose people. Take metformin with meals. from the liver.
Thiazolinediones (Glitazones) Combinations: Rosglitazone (Avandia) Glucovance (Glyburide/Metformin) Pioglitazone (Actos) Metaglip (Glipizide/Metformin) Avandamet (Rosglitazone/Metformin) These medicines help your body respond better ACTOplus met (Pioglitazone/Metformin) to insulin. Periodic liver blood tests are needed. Duetact (Pioglitazone/Glimepiride) Notify your doctor if you develop weight gain Janumet (Sitagliptin/Metformin) or swelling. Take with or without food. Kombiglyze (Saxigliptin/Metformin)
Alpha-Glucosidase Inhibitors Synthetic Amylin Acarbose (Precose) Pramlintide (Smylin) Miglitol (Glyset) This medication slows the rate of movement These medicines work in your stomach and of food from stomach to intestine and signals bowels to slow down the absorption of sugars the liver to decrease glucose output. and carbohydrates. They can cause abdominal pain, gas and diarrhea. Take with the first bite Incretin Mimetic of food at each meal. Exenatide (Byetta, Bydureon) Liraglutide (Victoza) Insulin Secretagogues (Meglitinides) Repaglinide (Prandin) Incretin is a natural hormone that your body Nateglinide (Starlix) makes. Incretin memetics act like (mimic) the incretins in your body that lower blood sugar These medications increase insulin secretion. after eating. These medicines cause your Take your medicine one to thirty minutes pancreas to release insulin when blood sugar before meals to control your blood sugar. is rising.
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High Blood Sugar—Hyperglycemia Low Blood Sugar—Hypoglycemia
High blood sugar may occur within hours or Low blood sugar usually occurs quickly and may develop over several days. You may have may require that someone help you get one or all of the following symptoms: treatment. Symptoms include: • High blood sugar levels (over 200) • Sweating • Extreme thirst • Shaking • Fatigue/sleepiness • Fast and/or pounding heartbeat • Using the bathroom a lot • Hunger • Grouchiness • Irritability/Confusion • Pain in stomach with or without nausea • Fainting and vomiting Causes of low blood sugar include: Causes of high blood sugar include: • Too much insulin or too many diabetes pills • Too much food or eating the wrong foods • Not enough food or missing a meal • Not enough diabetes pills or insulin • Too much exercise, or extra physical activity • Illness or infection • Not enough exercise (Do not exercise if your What to do to prevent hypoglycemia: sugar is above 240) Try to test your blood sugar. If you are too shaky, • Stress eat or drink a fast-acting carbohydrate such as: • 4 ounces juice (orange, apple, cranberry What to do to prevent hyperglycemia: or grape) • Always take your diabetes medicine unless your • 6 ounces (1/2 can) of a regular soft drink doctor tells you not to. • 8 ounces skim milk • Test your blood sugar every four to six hours. • 3 glucose tablets • If you usually take insulin, test your urine for • 8 Sweet Tart candies ketones. Call your doctor if moderate to large • 2 tablespoons raisins ketones are present. • If your blood sugar is over 150, drink 8 ounces Test blood sugar every 15 to 30 minutes of sugar-free liquid every one to two hours. until it is above 100. Eat a second fast-acting • Call your doctor if you are vomiting and unable carbohydrate if needed. If your next regular to eat or drink liquids. meal is more than two hours away, eat a snack such as half a sandwich or three peanut butter Remember to call your doctor if your blood or cheese crackers. sugar stays above the goals you’ve been given for 24 hours. If you are unconscious, someone should call 911 immediately. You should not be given anything by mouth if you are unconscious.
Be sure to tell your doctor about this episode in case your medication needs to be adjusted.
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Avoiding Complications of Diabetes Skin Care • Inspect your entire body every day for minor Diabetes can affect every organ of your body, cuts or scratches. If you can’t see the bottoms especially your eyes, your heart, your kidneys, of your feet, have someone look for you or use your nerves and your feet. You may be able a hand mirror. to avoid these problems by controlling your • Wash daily with soap and lukewarm water. Dry blood sugar. yourself completely. Pay special attention to the areas between your toes. For well-controlled blood sugar, you should: • Use lotion to add moisture to your skin and feet. • Test your blood sugar. Keep it in the ranges Avoid leaving lotion between your toes, because suggested by your health care professional. the moisture can cause athlete’s foot. • Have your A1c tested every three to six months to • Trim your toenails after bathing when they are be sure your sugar is in control even when you are softer. Cut them no shorter than the end of your not testing (like when you are sleeping). toe. Be careful to trim them straight across. • Sit down with a dietitian, who can give you a meal • If you have trouble trimming your toenails or plan that you can follow. cannot see your toenails clearly, a podiatrist (foot • Exercise regularly. doctor) can trim them for you. • Take all of your medication as ordered. • Make sure your shoes fit well. Put your hand in • Use no tobacco products or recreational drugs. your shoe to be certain you have no tears or holes • Limit alcohol. The dietitian will help you with types in the lining of your shoes. and amounts. • Socks should fit well and have no holes. • Check your feet every day to be certain there are • Clean any cuts/scratches with warm soapy water. no new cuts, corns, reddened areas, increased Place a thin coating of antibiotic ointment (such warmth, swelling, etc. as Polysporin or Neosporin) on the cut and cover • See your doctor regularly. with a bandage. • Keep your blood pressure well controlled (under 120/80). Remember to see your doctor if you notice: • Lose weight if you are overweight. • Abnormal color anywhere on your skin or feet. • Keep your cholesterol levels under control: Keep • Signs of infection such as redness, swelling, or your LDL under 100, your HDL over 40 for men increased warmth. and over 50 for women, and your triglycerides • Itchy, cracked areas between your toes or on under 150. your heels. • Prevent or manage symptoms of metabolic • Ingrown toenails, corns, calluses or painful areas syndrome. on your feet. • Any cuts/scratches or sores that do not heal Taking Good Care completely within two weeks. of Your Feet and Skin
When you have diabetes, you are more likely to have foot or skin infections. These can be very serious. Therefore, you need to take extra care to protect your feet and skin.
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Standards of Care
Special tests and exams need to be part of your diabetes care. Below are guidelines from the American Diabetes Association.
Test or Exam Frequency
Routine physical exam Once a year
Blood pressure At every routine exam
Lipid (cholesterol) test Yearly; if low-risk, every two years
Complete foot exam Yearly, including sensory (nerve) test
Yearly, or as recommended by your Eye exam eye doctor
Microalbumin (protein) urine test Yearly
Hemoglobin A1c (HbA1c) Every three months
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Resources Other Resources
Our hospitals have a tremendous Diabetes Forecast education program for people with A monthly magazine published by diabetes. For information, call Diabetes the American Diabetes Association. Outpatient Education: To subscribe, call 1 800 DIABETES.
Bethesda North Hospital 513 569 6777 American Association of Diabetes Educators Good Samaritan Hospital 513 569 6602 To find a diabetes educator near you: diabeteseducator.org Insurance coverage of your diabetes education should be verified before your American Diabetes Association: first scheduled appointment. Otherwise, diabetes.org you will be responsible for payment when you receive the bill. JDRF jdrf.org Based on your insurance coverage or by personal self-pay arrangement, you will be National Diabetes Education Program: scheduled to see the diabetes nurse educator ndep.nih.gov and registered dietitian for thirty minutes to one hour each on three separate visits. You also will be encouraged to schedule a visit with an exercise specialist of your choice, or as recommended by your doctor. All appointments will be made at approximately one-month intervals. The number of appointments will be modified according to individual needs. It is preferred that the first two visits be scheduled with your first phone call.
Learning to manage diabetes is the best way to minimize the potential complications of this disease. We want you to take an active part as an informed member of your diabetes team, along with your physicians, nurse educator, dietitian, and exercise specialist.
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